title: Pulse pressure is more susceptible to the white coat effect than is systolic blood pressure: observations from real-life ambulatory blood pressure monitoring.
abstract: BACKGROUND
  Pulse pressure is a derivative of arterial stiffness. We have previously demonstrated ambulatory pulse pressure to be relatively independent from the blood pressure (BP) lowering during sleep, and thus of a neurogenic effect. On the other hand, white coat BP effects are thought to involve neurogenic activation. The aim of this work was to analyze white coat induced variability in pulse pressure.
  
  
  METHODS
  Percent clinic-awake differences in systolic BP (SBP) and pulse pressure (white coat effects) were calculated for 688 consecutive subjects (mean age 60 +/- 16 years, 58% female). Of the subjects, 23% had controlled hypertension, 45% uncontrolled hypertension, 8% normotension, and 4% isolated office hypertension; all were referred to our unit for 24 h ambulatory BP monitoring.
  
  
  RESULTS
  Pulse pressure highly correlated with SBP (r = 0.82, P <.00001). We found a larger white coat effect on pulse pressure than on SBP (8.3% and 5.2%, respectively, P < or =.0001). This was true in all subgroups except in normotensive subjects. Specifically, the magnitude of the white coat effect on pulse pressure was greater than on SBP in subjects with treated hypertension, untreated hypertension, and isolated office hypertension, and in young hypertensive subjects, older subjects, and those with diabetes.
  
  
  CONCLUSIONS
  Although pulse pressure is related to the mechanical properties of large arteries, it is also influenced by the white coat effect, a neurogenic process. Furthermore, in hypertensive but not in normotensive subjects, the white coat effect on pulse pressure is significantly more pronounced than on SBP.
authors.affiliation: Department of Internal Medicine, Hadassah University Hospital, Mount-Scopus, Jerusalem, Israel. vp02292@netvision.net.il
authors.forename: Iddo Z
authors.initials: IZ
authors.lastname: Ben-Dov
authors.forename: Gila
authors.initials: G
authors.lastname: Perk
authors.forename: Liora
authors.initials: L
authors.lastname: Ben-Arie
authors.forename: Judith
authors.initials: J
authors.lastname: Mekler
authors.forename: Michael
authors.initials: M
authors.lastname: Bursztyn
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000187:drug effects / Q000502:physiology; D003971:Diastole / Q000187:drug effects / Q000502:physiology; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology; D007557:Israel; D008297:Male; D008875:Middle Aged; D013223:Statistics as Topic; D013599:Systole / Q000187:drug effects / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents