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Treatment of white coat hypertension

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Abstract

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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References and Recommended Reading

  1. Pickering TG, James GD, Boddie C, et al.: How common is white coat hypertension? JAMA 1988, 259:225–228.

    Article  PubMed  CAS  Google Scholar 

  2. Pickering TG, Coats A, Mallion JM, et al.: White-coat hypertension. Blood Press Monit 1999, 4:333–341. Reviews the incidence, significance, and management of white coat hypertension.

    PubMed  CAS  Google Scholar 

  3. Hoegholm A, Kristensen KS, Bank LE, et al.: White-coat hypertension and target organ involvement: the impact of different cut-off levels on albuminuria and left ventricular mass and geometry. J Hum Hypertens 1998, 12:433–439.

    Article  PubMed  CAS  Google Scholar 

  4. Staessen JA, O‘Brien ET, Amery AK, et al.: Ambulatory blood pressure in normotensive and hypertensive subjects: results from an international database. J Hypertens 1994, 12(suppl 7):S1-S12.

    CAS  Google Scholar 

  5. Verdecchia P, Schillaci G, Borgion C, et al.: White coat hypertension and white coat effect. Similarities and differences. Am J Hypertens 1995, 8:790–798.

    Article  PubMed  CAS  Google Scholar 

  6. The Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The sixth report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1997, 157:2413–2446.

    Article  Google Scholar 

  7. Mancia G, Bertinieri G, Grassi G, et al.: Effects of blood pressure measurement by the doctor on patient‘s blood pressure and heart rate. Lancet 1983, 11:695–698.

    Article  Google Scholar 

  8. World Health Organization-International Society of Hypertension guidelines for the management of hypertension. J Hypertens 1999, 17:151–183.

  9. O‘Brien E, Staessen J: Normotension and hypertension as defined by 24 hr ambulatory blood pressure monitoring. Blood Press 1995, 4:266–282.

    PubMed  CAS  Google Scholar 

  10. Staessen JA, Bieniaszewski L, O‘Brien ET, et al.: An epidemiological approach to ambulatory blood pressure monitoring: the Belgian population study. Blood Press Monit 1996, 1:13–26.

    PubMed  Google Scholar 

  11. Verdecchia P, Schillaci G, Boldini F, et al.: Variability between current definitions of “normal” ambulatory blood pressure. Implications in the assessment of white coat hypertension. Hypertension 1992, 20:555–562.

    PubMed  CAS  Google Scholar 

  12. Bindlingmeyer I, Burnier M, Bindlingmeyer M, et al.: Isolated office hypertension: a prehypertensive state? J Hypertens 1996, 14:327–332.

    Article  Google Scholar 

  13. Meyers MG, Reeves RA: White coat effect in treated hypertensive patients: sex differences. J Hum Hypertens 1995, 9:729–733.

    Google Scholar 

  14. Meyers MG, Oh PI, Reeves RA, et al.: Prevalence of white coat effect in treated hypertensive patients in the community. Am J Hypertens 1995, 8:591–597.

    Article  Google Scholar 

  15. Lantelme P, Milon H, Gharib C, et al.: White coat effect and reactivity to stress: cardiovascular and autonomic nervous system responses. Hypertension 1998, 31:1021–1029.

    PubMed  CAS  Google Scholar 

  16. Bhatt DL, James GD, Pickering TG, et al.: Relation of arterial pressure level and variability to left ventricular geometry in normotensive and hypertensive adults. Blood Press Monit 1996, 1:415–424.

    PubMed  Google Scholar 

  17. Myers MG: Ambulatory blood pressure monitoring in treated hypertensive patients: implications for clinical practice. J Hum Hypertens 1996, 10(suppl 2):527–531.

    PubMed  Google Scholar 

  18. Guida L, Lannuzzi R, Crivaro M, et al.: Clinic daytime blood pressure differences and cardiovascular damage. J Hypertens 1999, 17:331–337.

    Article  PubMed  CAS  Google Scholar 

  19. Palatini P, Penzo M, Canali C, et al.: Interactive action of the white-coat effect and the blood pressure levels on cardiovascular complications in hypertension. Am J Med 1997, 103:208–216.

    Article  PubMed  CAS  Google Scholar 

  20. Martinez MA, Garcia-Puig J, Martin JC, et al.: Frequency and determinants of white coat hypertension in mild to moderate hypertension: a primary care based study. Am J Hypertens 1999, 12:251–259.

    Article  PubMed  CAS  Google Scholar 

  21. Fogari R, Corradi L, Zoppi A, et al.: Repeated office blood pressure controls reduce the prevalence of white-coat hypertension and detect a group of white-coat normotensive patients. Blood Press Monit 1996, 1:51–54.

    PubMed  Google Scholar 

  22. Trenkwalder P, Plaschke M, Steffes-Tremer I, et al.: “White coat” hypertension and alerting reaction in elderly and very elderly hypertensive patients. Blood Press 1993, 2:262–271.

    PubMed  CAS  Google Scholar 

  23. Staessen J, Amery A, Fagard R: Isolated systolic hypertension. J Hypertens 1990, 8:393–405.

    Article  PubMed  CAS  Google Scholar 

  24. Palatini P, Dessina AC: A new approach to define the upper normal limits of ambulatory blood pressure. J Hypertens 1990, 8(suppl 6):S65-S70.

    CAS  Google Scholar 

  25. Staessen JA, Beilin L, Parati G, et al.: Task force IV: clinical use of ambulatory blood pressure monitoring. Blood Press Monit 1999, 4:319–331. Review paper discussing the advantages of ABP monitoring regarding treatment of hypertension.

    PubMed  CAS  Google Scholar 

  26. Cavallini MC, Roman MJ, Pickering TG, et al.: Is white coat hypertension associated with arterial disease or left ventricular hypertrophy? Hypertension 1995, 26:413–419.

    PubMed  CAS  Google Scholar 

  27. Palatini P, Mormino P, Santonastaso M, et al.: Target-organ damage in stage 1 hypertensive subjects with white coat and sustained hypertension: results from the HARVEST study. Hypertension 1998, 31:57–63.

    PubMed  CAS  Google Scholar 

  28. Pierdomenico SD, Lapenna D, Guglielmi MD, et al.: Target organ status and serum lipids in patients with white coat hypertension. Hypertension 1995, 26:801–807.

    PubMed  CAS  Google Scholar 

  29. Polonia JJ, Santos AR, Gama GM, et al.: Follow-up clinic and ambulatory blood pressure in untreated white-coat hypertensive patients (evaluation after 2–5 years). Blood Press Monit 1997, 2:289–295.

    PubMed  Google Scholar 

  30. White WB, Schulman P, McCabe EJ, et al.: Average daily blood pressure, not office blood pressure, determines cardiac function in patients with hypertension. JAMA 1989, 261:873–877.

    Article  PubMed  CAS  Google Scholar 

  31. Cerasola G, Cottone S, Nardi E, et al.: White-coat hypertension and cardiovascular risk. J Cardiovasc Risk 1995, 2:545–549.

    Article  PubMed  CAS  Google Scholar 

  32. Cardillo C, DeFelice F, Campia U, et al.: Psychophysiological reactivity and cardiac end-organ changes in white coat hypertension. Hypertension 1993, 21:836–844.

    PubMed  CAS  Google Scholar 

  33. Kuwajima I, Suzuki Y, Fujisawa A, et al.: Is white coat hypertension innocent? Structure and function of the heart in the elderly. Hypertension 1993, 22:826–831.

    PubMed  CAS  Google Scholar 

  34. Pose-Reino A, Gonzales-Juanatey JR, Pastor C, et al.: Clinical implications of white coat hypertension. Blood Press 1996, 5:264–273.

    PubMed  CAS  Google Scholar 

  35. Hoegholm A, Bang LE, Kristensen KS, et al.: Microalbuminuria in 411 untreated individuals with established hypertension, white coat hypertension and normotension. Hypertension 1994, 24:101–105.

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  37. Perloff D, Sokolow M, Cowan RM, et al.: Prognostic value of ambulatory blood pressure measurements: further analyses. J Hypertens 1989, 7(suppl 3):S3-S10.

    CAS  Google Scholar 

  38. Perloff D, Sokolow M: Ambulatory blood pressure: mortality and morbidity. J Hypertens 1991, 9(suppl 8):S31-S33.

    CAS  Google Scholar 

  39. Khattar RS, Senior R, Lahiri A: Cardiovascular outcome in white-coat versus sustained mild hypertension: a 10 year follow-up study. Circulation 1998, 98:1982–1987.

    Google Scholar 

  40. Pickering TG, James GD: Ambulatory blood pressure and prognosis. J Hypertens 1994, 12(suppl 8):S29-S33.

    CAS  Google Scholar 

  41. Clement DL, DeBuyzene M, Duprez D: Ambulatory blood pressure and prognosis: summary of ongoing studies. J Hypertens 1991, 9(suppl 8):S51-S53.

    CAS  Google Scholar 

  42. Zanchetti A, Bond G, Henning M, et al.: Risk factors associated with alterations in carotid intima-media thickness in hypertension: baseline data from the European Lacidipine Study on Atherosclerosis. J Hypertens 1988, 16:949–961.

    Article  Google Scholar 

  43. Brown MJ, Castaigne A, Puilope LM, et al.: INSIGHT: International Nifedipine GITS Study Intervention as a Goal of Hypertension Treatment. J Hum Hypertens 1996, 10(suppl 3):S157-S160.

    PubMed  Google Scholar 

  44. Fagard R, Bielen E, Staessen J, et al.: Response of ambulatory blood pressure to antihypertensive therapy guided by clinic pressure. Am J Hypertens 1993, 6:648–653.

    PubMed  CAS  Google Scholar 

  45. Pickering TG, Levenstein M, Warmsley P: Differential effects of doxazosin on clinic and ambulatory pressure according to age, gender, and presence of white coat hypertension. Results of the HALT study. Am J Hypertens 1994, 7:848–852.

    PubMed  CAS  Google Scholar 

  46. Fitscha P, Meisner W: Indications for antihypertensive treatment: superiority of ambulatory vs casual blood pressure measurement. Blood Press 1994, 3:36–39.

    Google Scholar 

  47. Weber MA, Cheung DG, Graettinger WF, et al.: Characterization of antihypertensive therapy by whole-day blood pressure monitoring. JAMA 1988, 259:3281–3285.

    Article  PubMed  CAS  Google Scholar 

  48. Hoegholm A, Winberg N, Kristensen KS: The effect of antihypertensive treatment with dihydropyridine calcium antagonists on white coat hypertension. Blood Press Monit 1996, 1:375–380.

    PubMed  Google Scholar 

  49. Herpin D, Vaisse B, Pilot M, et al.: Comparison of angiotensinconverting enzyme inhibitors and calcium antagonists in the treatment of mild to moderate systemic hypertension according to baseline ambulatory blood pressure level. Am J Cardiol 1992, 69:923–926.

    Article  PubMed  CAS  Google Scholar 

  50. Kristensen KS, Winberg N, Hoegholm A, et al.: Benazepril versus felodipine as supplement to bendroflumethiazide: evaluation by office and ambulatory blood pressure. Blood Press Monit 1998, 3:115–120.

    PubMed  Google Scholar 

  51. Hansson L, Zanchetti A, Caruthers SG, et al.: Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 1998, 351:1755–1762.

    Article  PubMed  CAS  Google Scholar 

  52. White WB, Daragjati C, Monsoor GA, et al.: The management and follow-up of patients with white-coat hypertension. Blood Press Monit 1996, 1(suppl 2):S33-S36.

    Google Scholar 

  53. Verdecchia P, Schillaci G, Borgioni C, et al.: Identification of subjects with white-coat hypertension and persistently normal ambulatory blood pressure. Blood Press Monit 1996, 1:217–222.

    PubMed  Google Scholar 

  54. Palatini P, Dorigatti F, Roman E, et al.: White-coat hypertension: a selection bias? Hypertension and Ambulatory Recording Venetia Study. J Hypertens 1998, 16:977–984.

    Article  PubMed  CAS  Google Scholar 

  55. Chrysant SG, Miller E: Effects of atenolol and diltiazem-SR on exercise and pressure load in hypertensive patients. Clin Cardiol 1994, 17:370–674.

    Article  Google Scholar 

  56. Staessen JA, Byttebier G, Buntinx F, et al.: Antihypertensive treatment based on conventional or ambulatory blood pressure measurement. A randomized controlled trial. JAMA 1997, 278:1065–1072. Large clinical trial presenting data on the significance of ABP monitoring with regard to treatment decisions.

    Article  PubMed  CAS  Google Scholar 

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  1. Oklahoma Cardiovascular and Hypertension Center, University of Oklahoma, 5850 W. Wilshire Boulevard, 73132-4904, Oklahoma City, OK, USA

    Steven G. Chrysant MD, PhD

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Chrysant, S.G. Treatment of white coat hypertension. Current Science Inc 2, 412–417 (2000). https://doi.org/10.1007/s11906-000-0046-7

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