[Medical stress and blood pressure]

Area of Science:

• Cardiology
• Hypertension Research
• Clinical Measurement

Background:

• Physician-measured blood pressure can elevate heart rate and blood pressure, known as the white coat effect.
• This phenomenon occurs in both normotensive and hypertensive individuals and is difficult to identify clinically.
• Differentiating white coat effect from sustained hypertension is vital due to differing cardiovascular complication rates.

Purpose of the Study:

• To highlight the importance of identifying the white coat effect.
• To discuss methods for avoiding overestimation of blood pressure due to this effect.
• To emphasize the necessity of out-of-office measurements for diagnosis.

Main Methods:

• Review of clinical identification challenges for white coat effect.
• Discussion of strategies to mitigate measurement bias, such as extended delays or nurse-taken readings.
• Emphasis on ambulatory or home blood pressure monitoring for definitive diagnosis.

Main Results:

• White coat effect is characterized by elevated blood pressure solely in clinical settings.
• Out-of-office blood pressure recordings are essential for accurate diagnosis.
• The prognosis for white coat effect differs significantly from permanent hypertension.

Conclusions:

• Accurate identification of white coat effect is critical for appropriate patient management.
• Ambulatory or home blood pressure monitoring is the gold standard for confirming white coat effect.
• Treatment decisions should be guided by out-of-office blood pressure measurements.