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White-coat resistant hypertension

A Mezzetti1, S D Pierdomenico, F Costantini

  • 1Centro per lo Studio dell' Ipertensione Arteriosa, delle Dislipidemie e dell' Arteriosclerosi, Istituto di Fisiopatologia Medica, Chieti, Italy. mezzetti@unich.it

American Journal of Hypertension
|December 16, 1997
PubMed
Summary
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Many patients with resistant hypertension actually have a "white-coat effect," where clinic blood pressure is high but ambulatory blood pressure is normal. This white-coat phenomenon persists despite medication and may lead to misdiagnosis and overtreatment.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Clinical Diagnostics

Background:

  • Resistant hypertension is diagnosed in patients with high blood pressure despite multiple medications.
  • The "white-coat effect" can elevate clinic blood pressure readings, potentially mimicking true resistant hypertension.
  • Distinguishing between true resistant hypertension and the white-coat effect is crucial for appropriate patient management.

Purpose of the Study:

  • To evaluate if sustained high clinic blood pressure in hypertensive patients on multiple drugs indicates true resistant hypertension or a persistent "white-coat effect."
  • To determine if the white-coat effect, observed before treatment, is maintained after pharmacological therapy.
  • To assess the clinical implications of differentiating between true resistant hypertension and white-coat resistant hypertension.

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Main Methods:

  • Ambulatory blood pressure monitoring (ABPM) was performed before treatment assignment in 250 essential hypertensives.
  • Twenty-seven patients with persistently high clinic blood pressure after 3 months of therapy underwent repeat ABPM.
  • Patients were classified based on clinic and ABPM readings using internal standards and other literature cutoffs.

Main Results:

  • Seven out of 27 patients (26%) had true resistant hypertension, while 20 (74%) exhibited a significant white-coat effect (white-coat resistant hypertension).
  • Classification varied slightly with different ABPM cutoff points, but the white-coat phenomenon remained a significant factor.
  • The white-coat effect persisted despite antihypertensive drug treatment and was associated with lower left ventricular mass index compared to true resistant hypertension.

Conclusions:

  • The white-coat phenomenon is a common cause of apparent resistant hypertension, leading to potential misdiagnosis.
  • Ambulatory blood pressure monitoring is essential to accurately diagnose resistant hypertension and avoid unnecessary treatment.
  • Differentiating white-coat resistant hypertension from true resistant hypertension may have implications for patient prognosis and management strategies.