White coat hypertension has been defined as the persistent elevation of blood pressure at the clinic or office only. It usually implies that daily ambulatory blood pressure is normal. The accepted cutoff for normal daytime ambulatory blood pressure is 135/85 mm Hg. The prevalence of white coat hypertension is high and varies from 20% to 45%. It appears to be more frequent in women, older patients, and persons with mild hypertension. White coat hypertension should not be confused with the white coat effect. The white coat effect signifies the difference in blood pressure between the office and daytime ambulatory blood pressure and occurs in patients with white coat hypertension as well as in patients with sustained hypertension that is treated or untreated. White coat hypertension is a benign condition, and the incidence of target-organ damage or cardiovascular morbidity and death is not significantly different from that in normotensive persons. Pharmacologic treatment should be withheld; instead, treatment should consist of lifestyle modification, moderate salt restriction, weight reduction, regular exercise, smoking cessation, and correction of glucose and lipid abnormalities. In addition, semiannual or annual follow-up with ambulatory blood pressure monitoring is advised.
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