Predictive Factors for White-Coat Hypertension

Abstract

The alerting reaction associated with the doctor’s visit or more in general with the situation of being in a medical environment causes important interference with blood pressure (BP) measurement in the clinical setting, possibly leading to misclassification of BP levels [1]. Indeed, more than 30 % of subjects who present an acute elevation of BP levels in the doctor’s office (white-coat effect, WCE) may be diagnosed as having white-coat hypertension (WCH, or isolated office hypertension, i.e., the condition characterized by persistently elevated office BP levels and normal ambulatory and/or home BP levels). In recognition of this, current hypertension guidelines have included the suspicion of WCH among the clinical indications for performing out-of-office BP monitoring [2, 3]. However, since performing ambulatory BP monitoring in all subjects who present with elevation in BP levels in the medical office is not always feasible, several studies have been conducted in the attempt to identify clinical and demographic factors that could help the practicing physician to suspect WCH and thus to reasonably proceed with performance ambulatory BP monitoring. However, no clear evidence has been so far provided regarding the clinical features that should be considered in order to raise this suspicion. The first pioneering studies implementing continuous intra-arterial BP recordings indicated that the magnitude of the WCE during a physician visit is largely variable among different subjects, which makes it hardly predictable in the individual patient [1]. Moreover, this interindividual variability in the magnitude of the WCE was not entirely explained by differences in clinical or demographic patients’characteristics (i.e., age, sex, 24-h BP levels) nor by the degree of spontaneous 24-h BP variability [1]. Inconclusive have also been the results of studies exploring the role of other potential predictors for WCE and WCH, such as the pressor response to physical and mental laboratory stress, psychobehavioral factors, or physical activity.