The white-coat hypertension response: prevalence and predictors

Area of Science:

• Cardiology
• Hypertension Research
• Clinical Psychology

Background:

• A subset of hypertensive patients display elevated blood pressure in clinical settings compared to ambulatory readings.
• Understanding the characteristics of these patients is crucial for accurate diagnosis and treatment.

Purpose of the Study:

• To identify the clinical characteristics differentiating patients with high office blood pressure (OBP) versus ambulatory blood pressure (ABP).
• To investigate if blood pressure elevations in the medical setting are linked to environmental reactivity or specific patient traits.

Main Methods:

• Comparison of office blood pressures (OBPs) and ambulatory blood pressures (ABPs) in patients undergoing hypertension treatment.
• Analysis of clinical characteristics, including age, disposition, anger expression, and medication use, in white-coat responders (WCRs) versus non-white-coat responders (NRs).

Main Results:

• 39% of patients were identified as white-coat responders (WCRs), with OBPs at least 10 mm Hg higher than ABPs.
• WCRs had higher systolic OBPs but significantly lower systolic and diastolic ABPs than NRs.
• White-coat hypertension was not associated with increased blood pressure reactivity in natural environments.
• WCRs were older, reported less anger, and were taking more antihypertensive medications.

Conclusions:

• Blood pressure elevation in the medical setting (white-coat hypertension) appears specific to the clinical environment, not indicative of heightened overall reactivity.
• Older age, specific personality traits (less anger), and higher medication burden characterize patients with white-coat hypertension.