Survey of white coat hypertension

Abstract

DECODE Study Group on behalf of the EuropeanDiabetes Epidemiology Study Group. Will new diagnostic criteria for diabetes mellitus change phenotype of patients with diabetes? Reanalysis of European epidemiological data.

Diagnostic value and cost-benefit analysis of 24 hours ambulatory blood pressure monitoring in primary care in Portugal

“…ABPM is a valuable tool for the diagnosis of masked hypertension a condition cursing with normotensive values in office and abnormally high pressure values outside the office setting that has been associated with an increased incidence target organ damage [33]. ABPM also allows to identify those individuals with white coat hypertension/isolated office hypertension (WCH) [1,4,6,12,16,21,24,34],[35] who exhibit a high blood pressure values in the doctor’s office in contrast with normal blood pressure values outside that setting. WCH cannot be diagnosed reliably on clinical examination alone.…”

“…Although there are some potential cost-effectiveness advantages for the use of HBPM in the diagnosis and management of hypertension by reducing the need for office visits, the net cost of home blood pressure monitorings and the absence of reimbursement by National Health Systems, as it occurs in Portugal, limits it generalization to a broad population and threatens its potential cost-effectiveness [38]. WCH has been associated with a low cardiovascular risk profile at least while comparing to sustained hypertensives [1,4,8,11,14,23-25,39]. Careful surveillance and implementation of healthy lifestyles but not pharmacological therapy has been recommended in WCH [1,4,24,25] and no study has so far clearly proven that drug treatment provides any benefit.…”

“…WCH has been associated with a low cardiovascular risk profile at least while comparing to sustained hypertensives [1,4,8,11,14,23-25,39]. Careful surveillance and implementation of healthy lifestyles but not pharmacological therapy has been recommended in WCH [1,4,24,25] and no study has so far clearly proven that drug treatment provides any benefit. Thus, the identification of WCH may have important consequences in reducing medical expenses related with drug treatment of hypertension, reducing the need of medical visits and exams [40].…”

“…It is now generally recognized that blood pressure (BP) measurement in office has several limitations. In recent years it has been shown that the evaluation of BP with ABPM for 24 hours has several advantages as compared to the BP measurement in office, namely a greater validity and reproducibility and higher predictive value of fatal and non-fatal cardiovascular events [4,6-15]. Furthermore, ABPM allows multiple BP measurements during 24 h that may be more representative of the daily BP burden, permits the evaluation of BP during the daily activities away of the BP alert reaction observed in office and allows the assessment of BP during sleep [9,11,14,16].…”

Blood pressure and its reactivity in the offspring of first cousin hypertensive and first cousin normotensive parents: a preliminary report

“…The stimulus used in this study was a relatively mild one compared to those used in other studies and yet the blood pressure increases were similar. 10,11 We have avoided using the clinical term 'white coat effect' since its use is already causing some controversy 14,15 and in our study we have used blood pressure readings taken after 30 min of rest as the baseline blood pressure as compared to the average 24-h blood pressure value used as a baseline for the definition of the 'white coat effect'. 14 Because reactivity of blood pressure to laboratory stimuli has been shown to be a significant prognostic marker for the subsequent development of hypertension 16 as well as for increases in left ventricular mass, 17 the exaggerated responses of these children to a relatively mild stimulus could be of prognostic importance especially in populations where consanguinity is common.…”