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[Influence of antihypertensive therapy on the "white coat effect"]
G Pannarale1, F Collauto, G L Serafini
1II Cattedra di Cardiologia, Università degli Studi di Roma La Sapienza.
Insights
The "White coat effect" or alarm reaction occurs in hypertensive patients, whether on medication or not, when their blood pressure is measured. Antihypertensive drugs may reduce heart rate response but not the blood pressure increase during measurement.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Medicine
Background:
- The
- White coat effect
- is a phenomenon where blood pressure increases upon measurement in a clinical setting.
- This reaction can occur in patients with hypertension, regardless of their medication status.
- Understanding this effect is crucial for accurate hypertension management.
Purpose of the Study:
- To evaluate the
- alarm reaction
- in hypertensive patients during blood pressure monitoring.
- To compare the blood pressure and heart rate responses between patients receiving and not receiving antihypertensive therapy.
Main Methods:
- Studied 64 hypertensive patients (38 male, 26 female, mean age 52 ± 11 years).
- Patients were divided into two groups: 23 untreated and 41 treated with antihypertensives.
- Non-invasive monitoring of arterial pressure (AP) and heart rate (HR) was performed, comparing baseline measurements (CAP, CHR) with daily means (MAP, MHR).
Main Results:
- Both treated and untreated hypertensive patients exhibited a significant increase in diastolic blood pressure from baseline (CAP) to daily monitoring (MAP) (p < 0.001).
- Treated patients showed a significant increase in systolic CAP compared to systolic MAP (p < 0.01).
- Untreated patients displayed a significantly higher baseline heart rate (CHR) compared to daily monitoring (MHR) (p < 0.001).
Conclusions:
- The
- alarm reaction
- to blood pressure measurement is evident in both treated and untreated hypertensive individuals.
- Antihypertensive therapy may attenuate the heart rate response but does not eliminate the pressure elevation associated with the
- White coat effect
- .
Abstract:
The aim of this study was to evaluate the alarm reaction when hypertensive patients either receiving or not receiving drug therapy have their blood pressure measured (the so-called "White coat effect"). A group of 64 patients (38 males and 26 females, mean age 52 +/- 11 years, OMS stage I-II) was studied. Twenty-three patients were not receiving antihypertensive therapy, 41 patients were regularly taking antihypertensive therapy prescribed by their own doctors. Non-invasive monitoring of arterial pressure (AP) and heart rate (HR) was carried out in all patients. The following parameters were examined in this study: mean of 3 measurements of AP and HR before monitoring (CAP, CHR), daily mean of AP and HR monitoring (MAP, MHR). The following results were obtained: 1) non-treated patients, CAP 157/108 +/- 19/11 mmHg, CHR 83 +/- 11 b/min, MAP 155/100 +/- 20/7 mmHg, MHR 76 +/- 7 b/min; 2) treated patients, CAP 151/96 +/- 21/16 mmHg, CHR 73 +/- 16 b/min, MAP 142/86 +/- 15/12 mmHg, MHR 70 +/- 10 b/min. The two-tailed "t"-test for paired data showed a statistically significant difference (p < 0.001) between diastolic CAP and diastolic MAP in both groups of patients. Systolic CAP was significantly greater than systolic MAP in treated patients (p < 0.01), whereas CHR was significantly higher than MHR in non-treated patients (p < 0.001). These data demonstrate that the alarm reaction to measuring blood pressure is present in both treated and non-treated hypertensive patients. Antihypertensive treatment appears to lessen the chronotropic but not the pressure response to measurement of AP in a hospital setting.