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Janus faces of the white coat effect: blood pressure not only rises, it may also fall
E Kumpusalo1, A Teho, R Laitila
1Department of Public Health and General Practice, Kuopio University, Finland, and General Practice, Kuopio University Hospital, Kuopio, Finland. Esko.kumpusalo@uku.fi
Insights
The white coat effect (WCE) in hypertension patients presents two reactions in general practice: an alerting WCE where blood pressure rises, and a relaxing WCE where it drops. This dual effect impacts hypertension management.
Area of Science:
- Cardiology
- Primary Care Medicine
- Hypertension Management
Background:
- Reliable hypertension control necessitates understanding the prevalence of the white coat effect (WCE).
- WCE is defined as a significant change in blood pressure (BP) readings between clinical and out-of-office measurements.
- Assessing WCE in primary care settings is crucial for accurate hypertension diagnosis and treatment.
Purpose of the Study:
- To evaluate the prevalence and characteristics of the white coat effect (WCE) in hypertensive patients within primary healthcare centers.
- To investigate both alerting and relaxing WCE phenomena observed during general practitioner (GP) visits.
Main Methods:
- A blinded, randomized study involving 210 hypertensive patients across six primary healthcare centers.
- Blood pressure (BP) and heart rate were measured twice in GP, nurse, and self-service rooms using a sphygmomanometer and an automatic device.
- 148 patients with successful self-measurements were included in the final analysis.
Main Results:
- One-third of patients (33%) exhibited a marked alerting WCE in the GP's room (systolic BP increase ≥ 10 mmHg and/or diastolic BP increase ≥ 5 mmHg).
- One in ten patients (10%) demonstrated a marked relaxing WCE in the GP's room (systolic BP decrease ≥ 10 mmHg and/or diastolic BP decrease ≥ 5 mmHg).
Conclusions:
- The white coat effect in general practice is characterized by both alerting and relaxing reactions.
- These dual WCE responses must be considered for effective hypertension management and accurate BP assessment.
Abstract:
For reliable control of hypertension, it is essential to know the prevalence of the white coat effect (WCE), which is defined as either a difference of 10 mmHg or more in systolic blood pressure (BP) and/or a difference of 5 mmHg or more in diastolic BP measured by a general practitioner (GP), a nurse, or the patient him/herself. The objective was to assess the WCE in hypertensive patients visiting GPs in primary healthcare centres. A blinded, randomised study in six primary healthcare centres was conducted, where eight GPs, nine nurses and 210 patients (92 men and 118 women) on a hypertension control regimen participated. Heart rate and BP in GPs', nurses' and self-service rooms were measured twice using a sphygmomanometer and an automatic device. Altogether, 148 patients (70%) performed the self-measurements of BP and heart rate perfectly successfully in all the three rooms. These were included in the final analyses. One out of three patients (33%) showed a marked alerting WCE in the GP's room (systolic BP rose by at least 10 mmHg and/or diastolic BP by at least 5 mmHg). On the contrary, one out of 10 (10%) showed a marked relaxing WCE in the GP's room (systolic BP decreased by at least 10 mmHg and/or diastolic BP by at least 5 mmHg). It can be concluded that the WCE in general practice has two faces: an alerting reaction and a relaxing reaction. This should be taken into account in hypertension control.