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'Home hypertension': exploring the inverse white coat response
N Donner-Banzhoff1, Y Chan, J P Szalai
1Department of Family and Community Medicine, Sunnybrook Health Science Centre, University of Toronto, North York, Canada.
Summary
Many patients exhibit lower blood pressure in the clinic than at home. Automatic home blood pressure devices may cause an alerting reaction, similar to the white coat response.
Area of Science:
- Cardiology
- Family Medicine
- Hypertension Research
Background:
- The 'white coat response' (elevated clinic blood pressure) is well-documented.
- The inverse phenomenon, lower blood pressure in clinic versus home, is less understood.
Purpose of the Study:
- To determine the prevalence of patients with higher home blood pressure than clinic readings.
- To identify demographic, clinical, and psychological factors associated with this pattern.
Main Methods:
- 214 patients from an academic family medicine clinic were studied.
- Exclusion criteria included age <16 and use of psychotropic or antihypertensive medications.
- Clinic-Home Blood Pressure Difference (CHBPD) was calculated; negative values indicated lower clinic readings.
Main Results:
- A significant proportion showed lower clinic blood pressure: 34.6% systolic, 23.8% diastolic.
- No significant differences were found in demographics, clinical factors, or psychological distress.
- Patients with lower clinic BP had higher readings on an automatic device at the clinic.
Conclusions:
- Measurement bias may contribute to higher out-of-clinic blood pressure readings.
- Automatic self-measurement devices can induce an alerting response, mirroring the white coat effect.