White coat hypertension: how should it be diagnosed?

Ambulatory Blood Pressure Monitoring: Technique and Application in the Study of Cardiac Dysfunction and Congestive Heart Failure

“…24 Depending on the definitions used, the prevalence of this condition may be as high as 10%-20%. 25 The clinical significance of white-coat hypertension continues to be debated, with cross-sectional studies providing conflicting results. 26 In summary, the careful follow-up of white-coat hypertensive patients has shown an equal rate of development of sustained hypertension as in an age-matched group.…”

“…This pressor effect is actually somewhat generic to the medical care environment, and its detection is the most commonly cited indication for ABPM in consensus documents 24 . Depending on the definitions used, the prevalence of this condition may be as high as 10%–20% 25 …”

Blood pressure measurement is changing!

“…In advocating the use of ambulatory measurement annually to follow people with white coat hypertension, the fiscal argument is often invoked, namely that the technique is too expensive to justify such a recommendation, and that indiscriminate use of ABPM would place an intolerable burden on health care services. Studies on the economics of ABPM are few, and the fear of inappropriate use, especially in private practice, has had a negative influence 4. However, the main riposte to the financial argument must be that if drug treatment is postponed or averted, the savings in pharmacological costs far outweigh the technologic costs of using ABPM.…”

A psychophysiologic reaction to application of ambulatory blood pressure monitor

“…Despite many research findings demonstrating the usefulness of ABPM in issues such as white coat hypertension [1][2][3][4], alerting reaction [5][6][7][8], circadian patterns-dipping and nondipping [9][10][11][12], variability [11,12], masked hypertension [13,14], and the management of hypertension [15], less is known about the interpretation of the initial manual calibration readings (when placing the monitor on an individual) and also these same readings at study completion (when removing the monitor) [12][13][14][15][16]. These readings are often higher than in the subsequent hours of ABPM when evaluated in white coat or sustained hypertensive groups [17].…”