A case of an extreme white coat effect

Area of Science:

• Cardiology
• Hypertension Research
• Clinical Case Studies

Background:

• A 63-year-old woman presented with consistently high systolic blood pressure (BP) readings exceeding 200 mmHg during office and ambulatory monitoring.
• Standard antihypertensive medications, including an angiotensin-converting enzyme (ACE) inhibitor, were poorly tolerated, causing significant adverse effects.

Observation:

• Finger-cuff BP monitoring revealed extreme hypertension specifically during interactions with healthcare professionals.
• Conversely, the patient exhibited hypotension when unobserved and seated alone, highlighting a significant stress-induced BP variability.

Findings:

• The patient demonstrated a profound white-coat hypertension phenomenon, with BP readings drastically differing based on the presence of medical personnel.
• This extreme BP variability under stress was implicated as a potential cause of a subsequent hemorrhagic stroke.

Implications:

• This case underscores the importance of considering stress-induced blood pressure fluctuations in clinical practice.
• Accurate BP assessment may require utilizing unobserved monitoring techniques in patients with suspected exaggerated responses.
• Understanding such extreme physiological responses is crucial for preventing severe cardiovascular events like stroke.