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White coat effect and reactivity to stress: cardiovascular and autonomic nervous system responses

P Lantelme1, H Milon, C Gharib

  • 1Hospices Civils de Lyon, Hôpital de la Croix-Rousse et Faculté de Médecine Lyon Nord, France.

Hypertension (Dallas, Tex. : 1979)
|April 16, 1998
PubMed

Insights

The white coat (WC) effect in hypertensive patients is linked to increased blood pressure (BP) responses to stress and standing. This suggests a shared mechanism involving altered autonomic nervous system balance and potentially increased cardiovascular risk.

Area of Science:

  • Cardiovascular Physiology
  • Hypertension Research
  • Autonomic Nervous System Function

Background:

  • The "white coat" (WC) effect, an elevation in blood pressure (BP) during clinical measurements, is a recognized phenomenon.
  • Its precise physiological underpinnings and relationship to other BP-altering conditions remain incompletely understood.
  • Investigating the WC effect in the context of autonomic nervous system (ANS) modulation is crucial for understanding cardiovascular risk.

Purpose of the Study:

  • To further elucidate the precise nature of the white coat (WC) effect.
  • To investigate the correlation between the WC effect and blood pressure responses to mental stress and postural changes.
  • To assess autonomic nervous system (ANS) modulation and arterial distensibility in hypertensive and normotensive subjects during different BP measurement conditions.

Main Methods:

  • Beat-to-beat blood pressure (BP) and heart rate (HR) were measured using Finapres in 88 hypertensive and 18 normotensive subjects.
  • Measurements were taken at rest, during conventional BP measurement (WC period), mental stress (MS period), and standing (S period).
  • Blood pressure variability (BPV), heart rate variability (HRV), and pulse wave velocity (PWV) were analyzed to assess ANS function and arterial distensibility.

Main Results:

  • In hypertensive subjects, the WC effect significantly correlated with BP responses to stress and standing.
  • Increased low-frequency BPV was observed during WC, MS, and S periods in hypertensive individuals, suggesting altered sympathovagal balance.
  • Hypertensive subjects exhibited increased PWV, indicating impaired arterial distensibility, even at lower BP levels.

Conclusions:

  • The WC effect is associated with an enhanced BP response to standing and mental stress, sharing a common physiological basis.
  • These conditions are characterized by increased low-frequency BPV, pointing to a modified sympathovagal balance.
  • The WC effect may represent an increased cardiovascular risk due to its association with impaired arterial distensibility.

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