A pilot study of white-coat and labile hypertension: associations with diagnoses of psychosocial dysfunction

Variable blood pressure responses, manifesting either as a "white-coat" phenomenon or lability between office visits, confound hypertension management decisions. An attempt was made to determine whether these phenomena are associated with concurrent diagnoses of psychosocial dysfunction, therefore mitigating against antihypertensive medical therapy. Forty-seven patients with such variable blood pressure responses were identified in a rural family practice over a three-year period and compared to randomly selected age- and sex-matched controls for the following concurrent diagnoses: generalized anxiety, psychogenic spastic bladder, panic disorder, depression, alcohol use, chronic headache, fibromyalgia, temporomandibular joint syndrome, irritable bowel syndrome, and premenstrual syndrome. No statistical associations between white-coat hypertension and these diagnoses were demonstrated although a small sample size tempers conclusions. However, chi-square analysis (P < 0.01) of the phenomenon characterized by lability of blood pressure between different office visits demonstrated a statistical association with alcoholic hepatitis in men. White-coat hypertension is a diagnosis that may warrant disassociation from other psychosocial disorders, although further study is indicated. Physicians should remain attuned to the presence of lability of blood pressure in males and consider possible associations with alcoholism.