Clinical implications of white coat hypertension: an ambulatory blood pressure monitoring study

Abstract

Within routine clinical practice, white coat hypertension (where blood pressure is persistently higher in the presence of the doctor or nurse but normal outside the medical setting) makes the diagnosis and management of hypertension difficult. There are conflicting data regarding the prevalence and significance of white coat hypertension. This study has used ambulatory blood pressure monitoring to detect the presence of white coat hypertension in 186 patients referred to an out-patient hypertension unit. The presence of white coat hypertension was defined as an average office blood pressure (measured on three occasions over a 2-month period) of >140/90 mm Hg and an ambulatory awake blood pressure < or = 136/86 mm Hg. The prevalence of white coat hypertension in those patients with borderline hypertension (diastolic blood pressure 90-99 mm Hg) and those with mild-to-moderate hypertension (diastolic blood pressure > or = 100 mm Hg) was determined. Echocardiography was used to assess left ventricular mass index in patients with and without white coat hypertension. The prevalence of white coat hypertension in the total group was 23%. However, the prevalence was higher (33%) in those patients with borderline hypertension compared to 9% of those patients with mild-to-moderate hypertension. There was a statistically significant increase in left ventricular mass index in patients with no evidence of white coat hypertension (125 gm/m2) compared to those with white coat hypertension (102 gm/m2). We conclude that, if office blood pressure is used to identify patients with hypertension who may require treatment, some patients will be incorrectly diagnosed and may be treated inappropriately. We recommend that ambulatory blood pressure monitoring is used in the routine assessment of all newly diagnosed hypertensive patients. Furthermore, we recommend echocardiography in patients with borderline hypertension as some will already have an increased left ventricular mass index.

Metabolic syndrome in subjects with white-coat hypertension: impact on left ventricular structure and function

“…29 Other potential biologic mediators of LV hypertrophy in subjects with MetS may be certain peptide hormones, such as angiotensin II and leptin, which are secreted by white adipose tissue. 20 Our findings also suggest that the clustering of features of MetS, frequently described in WCHs, may be at least in part responsible for the cardiac abnormalities, and probably for the increased cardiovascular risk displayed in some, but not all, series regarding subjects with WCH [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] . On the other hand, the greater values of both LV mass and LV chamber diameter that we observed in WCHs without MetS when compared to those of normotensive controls, seem to indicate that WCH per se, independently of MetS, may not be innocuous for the heart.…”

“…1,2 Indeed, the studies that evaluated the effects of WCH on hypertensive target organ damage and on the occurrence of future cardiovascular events yielded conflicting results. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] It has long been recognized that hypertension tends to cluster with various anthropometric and metabolic abnormalities, including elevated triglycerides, reduced high-density lipoprotein (HDL) cholesterol, glucose intolerance, abdominal obesity and insulin resistance, which are the main features of the metabolic syndrome (MetS). MetS, which may precede the appearance of sustained hypertension, contributes to the development of hypertensive target organ damage and atherosclerotic diseases.…”

Increased prevalence of Chlamydophila pneumoniae but not Epstein–Barr antibodies in essential hypertensives

“…As a result of the existing controversy on whether white-coat hypertension is a benign condition or a pathophysiological entity leading to similar complications with sustained hypertension, 15,16 white-coat hypertensives were excluded from this study, to avoid possible methodological errors. In order to identify correctly sustained hypertensives, all participants underwent 24 h ambulatory blood pressure monitoring (ABPM).…”

White coat hypertension: how should it be diagnosed?

“…3 Manning and her colleagues make two observations on the condition in this issue of the Journal of Human Hypertension. 4 First, white coat hypertension (even allowing for differences of definition and referral bias) is common, but, of course not normal (or we would all exhibit the phenomenon), being present in about a quarter of their referral population. Second, white coat hypertension may not be altogether benign, as some 9% of their subjects had echocardiographic evidence of increased left ventricular hypertrophy.…”