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White coat hypertension in a general practice. Prevalence, cardiovascular risk factors and clinical implications
Insights
White coat hypertension (WCH) and white coat effect (WCE) are common in general practice, affecting 21% and 37% of mild hypertensives, respectively. Younger patients with WCH may face greater clinical challenges.
Area of Science:
- Cardiology
- General Practice
- Hypertension Management
Background:
- White coat hypertension (WCH) and white coat effect (WCE) represent distinct physiological responses to blood pressure measurement.
- Understanding their prevalence is crucial for accurate diagnosis and management of hypertension in primary care settings.
Purpose of the Study:
- To determine the prevalence of WCH and WCE in a general practice population.
- To compare the characteristics of patients with WCH to those with sustained hypertension.
Main Methods:
- Blood pressure was measured in-clinic by general practitioners and at-home by patients among 68 mild hypertensives.
- WCH was defined as elevated clinic BP with normal home BP; WCE was a ≥10 mmHg difference in systolic BP.
- Patients were compared based on background, biochemical, and cardiovascular risk factors.
Main Results:
- The prevalence of WCH was 21% (14 patients) and WCE was 37% (25 patients).
- Patients with WCH showed significant differences in age, total cholesterol, and heart rate compared to sustained hypertensives.
- Increasing age and heart rate were identified as negative predictors for WCH.
Conclusions:
- WCH presents a notable clinical challenge within general practice.
- The findings suggest that WCH may be particularly significant in younger patient populations, warranting further investigation and tailored management strategies.
Objective:
To examine the prevalence of white coat hypertension (WCH) and white coat effect (WCE) in a general practice. Background and biochemical characteristics, triglycerides, total cholesterol, HDL cholesterol, fasting blood glucose, microalbuminuria, ECG, smoking habits, height and weight of patients with white coat hypertension were compared to patients with sustained hypertension.
Design:
Blood pressure measurements among mild hypertensives in clinic visits by doctor and at home by the patients.
Setting:
A primary health centre in Oslo, Norway.
Subjects:
Sixty-eight patients with mild hypertension (41 females and 27 males) aged 20-75 years.
Main Outcome Measures:
Patients had their blood pressure measured in clinic visits by general practitioners and by themselves at home to study the prevalence of WCH and the WCE. WCH was defined as a consistently increased blood pressure in the clinic and a normal home-measured blood pressure. WCE was defined as a difference in mean systolic blood pressure measured by physician and patients of 10 mmHg, or more. An individual risk score for myocardial infarction was calculated. Subjects with and without WCH/WCE were compared in relation to background characteristics and biochemical differences.
Results:
Fourteen patients (21%) were found with WCH, while 25 (37%) had WCE. Patients with WCH differed significantly from hypertensives in age, total cholesterol, and heart rate. In multivariate analysis, increasing age and heart rate were significant negative predictors for WHC.
Conclusion:
WCH may be a significant clinical challenge in general practice, especially among younger patients.