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White coat hypertension: a follow-up
S Julius1, K Jamerson, T Gudbrandsson
1Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0356.
Summary
Home blood pressure monitoring revealed distinct hypertension groups. "White coat" hypertension, characterized by high clinic but normal home readings, shares risk factors with sustained hypertension, necessitating lifestyle interventions.
Area of Science:
- Cardiology
- Hypertension Research
- Preventive Medicine
Background:
- Self-monitoring of home blood pressure is a valuable tool for hypertension diagnosis.
- Differentiating between sustained and "white coat" hypertension is crucial for patient management.
Purpose of the Study:
- To compare home blood pressure readings with clinic readings in a large cohort.
- To identify characteristics of "white coat" hypertension versus sustained hypertension.
Main Methods:
- 937 participants from the Tecumseh Blood Pressure Study were analyzed.
- Home blood pressure was self-monitored (14 readings/7 days) and compared to clinic readings.
- Hypertension was defined by home readings in the upper decile or clinic readings >140/90 mmHg.
Main Results:
- Two hypertensive groups emerged: "sustained" (clinic and home hypertension) and "white coat" (clinic hypertension, normal home readings).
- Both groups exhibited similar characteristics: overweight, faster heart rates, elevated cholesterol, insulin, triglycerides, and decreased HDL.
- Elevated blood pressure readings were noted in childhood and adolescence for both groups compared to controls.
Conclusions:
- "White coat" hypertension shares cardiovascular risk factors with sustained hypertension.
- Individuals with "white coat" hypertension may be at increased risk for coronary heart disease and future sustained hypertension.
- Nonpharmacologic interventions are recommended for "white coat" hypertension to manage blood pressure and reduce coronary risk.