White coat hypertension

White coat hypertension A persistently elevated average office blood pressure greater than 140/90 mm Hg (stage 1) in the presence of a health care worker, whereas the patient otherwise has an average daytime ambulatory reading less than 135/85 mm Hg. 

Self-measurements of BP or automatic ambulatory BP monitoring can be useful to establish effective 24-hour control. These techniques are currently recommended only for select situations such as suspected white coat hypertension. 

ABP is clinically most useful in patients with suspected white-coat hypertension . It is also helpful in patients with apparent drug resistance, hypotensive symptoms with antihypertensive agents, episodic hypertension and autonomic dysfunction. However, this procedure should not be used indiscriminately, such as in the routine evaluation of patients with suspected hypertension. 

Researchers in Japan investigated white coat hypertension (WCH) in 128 subjects. At home, their blood pressure levels on average were 135/85. In the doctor s office they rose to 140/90. Many men and women experience even greater differences. 

As with WCH and LH, MH is best revealed by monitoring blood pressure either with occasional home monitoring or by wearing an ambulatory device provided by a physician who, for whatever reason, suspects MH. MH is also known in the medical community as reverse white coat hypertension and white coat normotension. This is particularly insidious, since such patients tend to be at even greater risk than are people with more commonly detected hypertension. 

Han KH, Choe SC, Kim HS, et al. Effect of red ginseng on blood pressure in patients with essential hypertension and white coat hypertension. Am J Chin Med 1998 26 199-209. 

Inaccuracies with indirect measurements result from inherent biologic variability of blood pressure, inaccuracies related to suboptimal technique, and the white coat effect. BP varies with environmental temperature, the time of day and year, meals, physical activity, posture, smoking, and emotions. Some patients have white coat hypertension, where BP values rise in a clinical setting but return to normal in nonclinical environments using home or ambulatory blood... 

Glen SK, Elliott HL, Curzio JL, et al. White-coat hypertension as a cause of cardiovascular dysfunction. Lancet 1996 348 654-657. 

This describes a situation in which the patient frequently forgets to take his/her medication. Perhaps 50-80% of the prescribed doses (e.g. tablets, capsules) are taken according to instructions. The medication cannot provide its full action, and the patient does not profit fully from treatment. For example, antihypertensives may appear to work when blood pressures are satisfactory at the consultation (a common white coat compliance ), but at other times the patient still has uncontrolled hypertension. These patients may unconsciously or consciously be responding to adverse events, too in some cultures they may be reticent to tell their doctors about this, and in other situations patients may want to avoid being withdrawn from clinical trials. Close treatment history taking is mandatory when such a patient is identified. 

Pickering, T.G. (1998). White coat hypertension time for action. 

P. Owens, N. Atkins, E. O Brien, Diagnosis of white coat hypertension by ambulatory blood pressure monitoring. Hypertension 34 (2) (1999) 267—272. 

Dustan HP (1990) Irvine Page lecture. Legacies of Irvine H. Page. J Hypertens Suppl 8 S29-S34 Franklin SS, Thijs L, Hansen TW et al (2013) White-coat hypertension new insights from recent studies. Hypertension 62 982-987... 

Pickering TG, James GD, Boddie C et al (1988) How common is white coat hypertension JAMA 259 225-228... 

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