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[The "white coat effect" in hypertensive patients]
Insights
The white coat effect, an elevation in blood pressure due to anxiety, was observed in 32% of hypertension patients. This phenomenon can significantly overestimate casual blood pressure readings.
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.
Abstract:
The "white coat effect" has been investigated by non-invasive automatic blood pressure monitoring in patients with hypertension, defined by casual blood pressure readings. A significant "white coat effect" has been demonstrated in 30 (32%) of the 93 patients: the average values were 17/9 mmHg and 6 beat/min, the highest values were 37/29 mmHg and 13 beat/min. The examination has been repeated after 24 hours in 11 cases and the phenomenon was reproducible. The "white coat effect" did not disappear even when the changes were compared to the averages of three subsequent automatic blood pressure measurements. There were significantly more women, than men among the "white coat" positive patients. However, no difference was found in age, occupation and the known duration of hypertension. Neither was any correlation between the "white coat effect" and the blood pressure reaction to mental arithmetic test. It is emphasized that the casual readings can significantly overestimate the blood pressure. This finding must be considered especially in the diagnosis of borderline hypertension.