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Prevalence of the white-coat effect at multiple visits before and during treatment

Willem J Verberk1, Abraham A Kroon, Theo Thien

  • 1Cardiovascular Research Institute Maastricht (CARIM), Maastricht University and Department of Internal Medicine, University Hospital Maastricht, Nijmegen, The Netherlands.

Journal of Hypertension
|November 4, 2006
PubMed

Insights

White-coat hypertension (WCH) and white-coat effect (WCE) are common in hypertensive patients, often persisting across multiple visits. Self-blood pressure monitoring (SBPM) and ambulatory blood pressure monitoring (ABPM) are crucial for accurate diagnosis and treatment adjustment.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Clinical Diagnostics

Background:

  • The white-coat effect (WCE) and white-coat hypertension (WCH) describe elevated blood pressure in a clinical setting compared to out-of-office measurements.
  • Understanding the prevalence and persistence of WCE and WCH is crucial for accurate hypertension diagnosis and management.
  • Current diagnostic methods may not fully capture the variability of blood pressure outside of clinical environments.

Purpose of the Study:

  • To investigate the prevalence and persistence of WCE and WCH in hypertensive patients.
  • To assess these phenomena across multiple blood pressure measurement occasions.
  • To compare findings in patients with and without antihypertensive treatment.

Main Methods:

  • 163 mild-to-moderate essential hypertensive patients underwent office blood pressure measurements (OBPM) over eight visits.
  • Self-blood pressure measurements (SBPM) were performed for one week prior to each visit.
  • 24-hour ambulatory blood pressure monitoring (ABPM) was conducted at the study's start and end.

Main Results:

  • A substantial WCE was observed at least once in 75% of patients, and WCH in 57%.
  • One-third of patients consistently showed a substantial WCE, and 14% consistently showed WCH.
  • The magnitude of WCE correlated with blood pressure height in treated, but not untreated, patients.

Conclusions:

  • WCH and substantial WCE can consistently occur in some patients across multiple office visits.
  • Individual WCE magnitude varies significantly, particularly in untreated patients.
  • Incorporating SBPM and/or ABPM is recommended for accurate hypertension diagnosis and treatment adjustment.
Abstract

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