[The "white coat effect" in hypertensive patients]

Area of Science:

• Cardiology
• Hypertension Research
• Clinical Measurement

Context:

• The white coat effect (WCE) is a phenomenon where blood pressure is elevated in a clinical setting compared to ambulatory or home readings.
• Accurate blood pressure measurement is crucial for diagnosing and managing hypertension, a widespread cardiovascular condition.

Purpose:

• To investigate the prevalence and reproducibility of the white coat effect in hypertensive patients using non-invasive automatic blood pressure monitoring.
• To determine factors associated with the white coat effect and its impact on blood pressure diagnosis.

Summary:

• A significant white coat effect was observed in 32% (30/93) of patients with hypertension, with average blood pressure increases of 17/9 mmHg and heart rate increases of 6 bpm.
• The phenomenon was reproducible upon re-examination and persisted even when compared to averaged subsequent measurements.
• Women were more likely to exhibit the white coat effect, but no associations were found with age, occupation, duration of hypertension, or response to a mental arithmetic test.

Impact:

• Casual blood pressure readings can significantly overestimate a patient's true blood pressure, potentially leading to misdiagnosis or unnecessary treatment.
• This finding is particularly important for the diagnosis of borderline hypertension, where accurate readings are critical.
• Highlights the need for considering ambulatory or home blood pressure monitoring to avoid overestimation in clinical settings.