Clinical implications of white coat hypertension

"White coat" or "office" hypertension is often defined as the transient rise or elevation of blood pressure that occurs in the medical setting. Patients with these elevated readings have normal ambulatory pressures as determined by individual home blood pressure measurements or continuous 24-hour blood pressure monitoring. This clinical finding is present in 20 to 40 percent of patients with hypertension. Although continuous blood pressure monitoring has several research implications, its use adds little to the diagnosis, prognosis and treatment options. Treatment decisions should be based on office blood pressure measurements evaluated in accordance with the recommended guidelines for the diagnosis of hypertension. The detection and confirmation of hypertension, as delineated in the fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure, is based on multiple office measurements. Ambulatory blood pressure monitoring should not be used for the routine diagnosis or management of most patients.