Blood Pressure Monitoring. Task force V: White-coat hypertension.
Two terms are in current use to describe patients whose blood pressures are high only in a medical setting (white-coat hypertension and isolated office or clinic hypertension). The term white-coat effect is also commonly used to describe the pressor response to the clinic setting.


BACKGROUND
White-coat hypertension is generally defined as a persistently elevated clinic blood pressure in combination with a normal ambulatory blood pressure (ABP). There is disagreement regarding the optimal cutoff point for ABP. The white-coat effect is operationally defined as the difference between the clinic blood pressure and daytime ABP. PREVALENCE OF WHITE-COAT HYPERTENSION: This varies according to the definition of white-coat hypertension and the population studied, but is approximately 20% among mild hypertensives, and increases with age.
Authors of some studies have suggested that white-coat hypertension is associated with metabolic abnormalities such as hyperlipidemia that lead to an increase in cardiovascular risk, but most have not found this. TARGET-ORGAN DAMAGE: Several measures of target-organ damage have been compared among normotensives, white-coat hypertensives, and sustained hypertensives; these include left ventricular mass, microalbuminuria, and carotid atherosclerosis. In general, target-organ damage in white-coat hypertension is less than that in sustained hypertension, but in some studies it has been found to be more prevalent than in normotensives.
Authors of a relatively small number of prospective studies have concluded that white-coat hypertensives have a lower risk of morbidity than do sustained hypertensives, but a larger number have drawn the more general conclusion that, when there is a discrepancy between the clinic blood pressure and ABP, the prognosis is more closely related to the ABP.


RESULTS
When white-coat hypertensives are prescribed antihypertensive medication there is usually a decrease in clinic blood pressure, but little or no change in ABP. Thus drug treatment is not necessarily indicated. Another issue is the follow-up of white-coat hypertensives; there is general agreement that blood pressure outside the office should be monitored indefinitely. Some patient may have been wrongly classified as white-coat hypertensives, and others may progress to develop sustained hypertension.
Pickering
T G
TG
Hypertension Center, New York Presbyterian Hospital, New York, USA. tpicker@mail.med.cornell.edu
Coats
A
A
Mallion
J M
JM
Mancia
G
G
Verdecchia
P
P
D000959:Antihypertensive Agents / Q000627:therapeutic use; D001786:Blood Glucose; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000378:metabolism / Q000523:psychology*; D017379:Hypertrophy, Left Ventricular / Q000209:etiology; D007328:Insulin / Q000097:blood; D008055:Lipids / Q000097:blood; D009017:Morbidity; D009819:Office Visits; D015995:Prevalence; D013315:Stress, Psychological
D000959:Antihypertensive Agents; D001786:Blood Glucose; D007328:Insulin; D008055:Lipids