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White Coat Hypertension: to Treat or Not to Treat?
Cesare Cuspidi1,2,3, Carla Sala4, Guido Grassi5,6
1Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy. cesare.cuspidi@unimib.it.
Insights
White coat hypertension (WCH), defined by elevated office blood pressure (BP) but normal out-of-office BP, carries intermediate cardiovascular risk. This review covers WCH prevalence, correlates, organ damage, and interventions.
Area of Science:
- Cardiology
- Hypertension Research
Background:
- White coat hypertension (WCH) is characterized by elevated office blood pressure (BP) with normal out-of-office BP.
- Evidence suggests WCH is associated with target organ damage and cardiovascular events, indicating intermediate risk.
Purpose of the Study:
- To review prevalence, clinical correlates, and cardiovascular associations of WCH.
- To discuss therapeutic interventions for WCH.
- To emphasize the definition of WCH based on 24-h ambulatory BP monitoring.
Main Methods:
- Review of accumulating evidence on WCH.
- Focus on data using the original WCH definition based on 24-h ambulatory BP monitoring.
- Exclusion of home BP measurements to avoid confounding factors like isolated nocturnal hypertension.
Main Results:
- WCH risk is intermediate between normotension and sustained hypertension.
- Association of WCH with target organ damage and cardiovascular events is significant.
- 24-h ambulatory BP monitoring provides a reliable definition of WCH.
Conclusions:
- WCH represents a distinct clinical entity with intermediate cardiovascular risk.
- Accurate diagnosis of WCH using ambulatory BP monitoring is crucial for risk assessment.
- Further research into WCH management is warranted.
Abstract:
Definition of white coat hypertension (WCH) traditionally relies on elevated office blood pressure (BP) during repeated visits concomitant with normal out-of-office BP values, as assessed by home and/or 24-h ambulatory BP monitoring measurements. Accumulating evidence focusing on the association of WCH with target organ damage and, more importantly, with cardiovascular events indicates that the risk conveyed by this condition is intermediate between normotension and sustained hypertension. This article will review a number of issues concerning WCH with particular emphasis on the following: (1) prevalence and clinical correlates, (2) association with target organ damage and cardiovascular events, (3) therapeutic interventions. Data will refer to the original WCH definition, based on out-of-office BP determined by 24-h ambulatory BP monitoring; at variance from home BP measurement, this approach rules out the potentially confounding effect of a clinically relevant abnormal BP phenotype such as isolated nocturnal hypertension.
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Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.