White Coat Hypertension: A Follow-Up

1992 ◽  
Vol 14 (1-2) ◽  
pp. 45-53 ◽  
Author(s):  
Stevo Julius ◽  
Kenneth Jamerson ◽  
Thorkell Gudbrandsson ◽  
Nicholas Schork
Keyword(s):  
White Coat ◽  
White Coat Hypertension

Follow-up of white-coat hypertension in the Hanshin-Awaji earthquake

The Lancet ◽  
1996 ◽  
Vol 347 (9001) ◽  
pp. 626-627 ◽  
Author(s):  
Kazuomi Kario ◽  
Takefumi Matsuo ◽  
Kazuyuki Shimada
Keyword(s):  
White Coat ◽  
White Coat Hypertension

P803Automatic measurement of blood pressure for one hour in the clinic predicts results of 24-hour ABPM in elderly hypertensive patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B S Stender ◽  
J Stender
Keyword(s):  
Blood Pressure ◽  
White Coat ◽  
White Coat Hypertension ◽  
Waiting Room ◽  
General Applicability ◽  
Non Invasive ◽  
White Coat Effect ◽  
Disturbed Sleep ◽  
Elderly Hypertensive

Abstract Introduction The gold standard in non-invasive assessment of blood pressure (BP) is 24-hour ambulatory BP measurement (24h-ABPM) due to frequent “office-” or “white coat hypertension” effects by measurement in the clinic. But 24h-ABPM is demanding, patients may report discomfort and stress from disturbed sleep. We compared BP measured automatically during one hour (1h-BP) in the waiting room of our clinic with that of 24h-ABPM among elderly hypertensives. Our aim was to investigate whether this less stressful procedure may replace 24h-ABPM in the outpatient follow-up of hypertensives. Hypotheses I) Mean diastolic and systolic BP values measured during one hour in a clinic equal those obtained by 24h-ABPM. II) The minimal BP during 1h-BP measurement equals mean 24h-BP during sleep. Material and methods The population comprised patients referred with known or suspected hypertension. Office BP was measured with Omron M7 Intelli IT. An ABPM apparatus reprogrammed to every 5 min. for one hour was mounted, and 1h-BP was obtained with the patient seated in the waiting room. 24h-ABPM was then performed at home. 110 patients were considered, 11 were excluded due to reported pain, stress or changes of medication, leaving 99 (m/f 32/66, age (SD) 70 (11)) for analysis. Sample size was set in a pilot study by a=0.05, b=0.05, effect size of BP differences systolic 5 (SD 13) and diastolic 3 (SD 8) mmHg. Results were analyzed with Student's paired t-test. Results We found a significant BP drop from office- to 1h- and 24h- BP measurements, i.e. a “white coat” effect. However, mean systolic 1h-BP and mean systolic 24h-BP did not differ, neither did minimal systolic 1h-BP and mean systolic 24h-BP during sleep. Mean diastolic 1h-BP was 4 mm Hg higher than that of 24h-ABPM, and minimal diastolic 1h-BP was 4 mmHg higher than mean diastolic 24h-BP during sleep. mmHg avg (SD) Office-BP 1h-BP mean 24h-BP mean 1h-BP minimum 24h-BPs mean during sleep Systolic 155 (18) 136 (13)* 135 (11)* 127 (12) 127 (13) Diastolic 90 (11) 80 (9)* 76 (8)* 74 (9) 70 (7) *“White-coat effect” significant in comparison with office-BP. No difference between mean systolic 1h-BP and mean systolic 24h-BP, p=0.67. No difference between mean diastolic 1h-BP minus 4 and mean diastolic 24h-BP, p=0.92. No difference between systolic 1h-BP minimum and mean systolic 24h-BP during sleep, p=0.65. Conclusion BP measurement for one hour in the waiting room by an ABPM apparatus may provide sufficient elimination of “office-” or “white coat effects” to replace 24h-ABPM in selected instances. The finding should be challenged in different clinical subpopulations to ensure general applicability.

P1556Cardiovascular risk in white-coat hypertension individuals stratified by their nocturnal blood pressure dipping status

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Liakos ◽  
E Karpanou ◽  
C Grassos ◽  
M Markou ◽  
G Vyssoulis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Smoking Status ◽  
White Coat ◽  
White Coat Hypertension ◽  
Risk Of Death ◽  
Nocturnal Blood Pressure ◽  
Cholesterol Levels ◽  
Lowering Drug ◽  
Nocturnal Blood Pressure Dipping

Abstract Background/Introduction Nocturnal blood pressure (BP) dipping status, defined by the night-to-day BP ratio, has been correlated with the cardiovascular (CV) risk in patients with arterial hypertension. The risk is higher in those with less than normal or no drop in nocturnal BP while data in extreme dippers are inconsistent. On the other hand, white-coat hypertension (WCHT), defined as an elevated office BP despite a normal out-of-office BP, is characterized by a lower CV risk than that of sustained hypertension and rather comparable with that of true normotension. Purpose The present study assessed the possible relation between the nocturnal BP dipping status and the underlying CV risk in WCHT individuals. Methods Among all individuals examined in our outpatient anti-hypertensive units over the past 15 years, 2310 (42% men, 52.2±13.1 years of age) were diagnosed with WCHT (increased office BP: 156.4±10.0/99.6±6.2 mmHg and normal 24-hour ambulatory BP: 122.4±6.3/75.3±5.4 mmHg) and were enrolled in the study. A night-to-day BP ratio (from the 24-hour ambulatory BP monitoring) 0.8–0.9 defined Normal nocturnal BP Dipping, <0.8 Extreme Dipping, 0.9–1 Mild Dipping and >1 Absence of Dipping. The underlying 10-year CV risk of death in the studied population was calculated with the Hellenic version of the HeartScore (Hellenic Score), as proposed by the current 2018 European Society of Hypertension guidelines, based on age, gender, smoking status, systolic BP and total cholesterol levels. Results From 2310 individuals studied, 1208 (52.3%) were found with Normal Dipping, 386 (16.7%) with Extreme Dipping, 622 (26.9%) with Mild Dipping and 94 (4.1%) with Absence of Dipping. Hellenic Score was 3.21±4.67% in subjects with Normal Dipping, 3.49±4.97% in those with Extreme Dipping, 3.66±5.04% in those with Mild Dipping, 6.21±7.29%, in those with Absence of Dipping (p for trend<0.05) and 3.50±4.99% in the whole cohort of the studied population. Conclusions Nocturnal BP dipping status is closely associated with the underlying CV risk of WCHT individuals. Extreme Dipping, Mild Dipping and especially Absence of Dipping increase CV risk thus necessitating closer follow-up of these individuals and possibly faster initiation of BP-lowering drug treatment.

Abstract 5: White Coat Hypertension Stability In Children And Adolescents: Pediatric Nephrology Research Consortium Study

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Yosuke Miyashita ◽  
Coral HANEVOLD ◽  
Anna Faino ◽  
Julia Scher ◽  
Marc B Lande ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Family History ◽  
Children And Adolescents ◽  
White Coat ◽  
White Coat Hypertension ◽  
Mixed Effect ◽  
Interval Time ◽  
Obstructive Sleep ◽  
History Of

There is no pediatric data on whether white coat hypertension (WCH) is a precursor of sustained HTN. The objective of this study was to determine diagnosis changes on follow-up ambulatory blood pressure monitoring (ABPM) in children and adolescents diagnosed with WCH on their initial ABPM and to assess for predictive factors of progression to HTN. Retrospective review was conducted at 11 centers to identify patients with WCH diagnosed by ABPM and had repeat ABPM at least 6 months after the first study. Subjects with secondary HTN, on antihypertensive medication, and diabetes mellitus were excluded. Patients with ADHD were included in the study if medications were stable. Chart review included associated risk factors such as BMI, obstructive sleep apnea, and family history of HTN. ABPM phenotype was determined using the 2014 AHA guidelines. The association between abnormal ABPM diagnosis on follow-up and ABPM index and blood pressure load variables was assessed using univariable generalized linear mixed effect models. Significant ABPM index and load variables (based on p < 0.15) were subsequently added to a multivariable model with the following pre-specified covariates: gender, family history of HTN, age, BMI z-score, ADHD, and interval time between ABPMs. One hundred and one patients met criteria for inclusion with a median age of 14 years (80% males) and median interval time of 14 months (range: 6 – 55 months). On follow-up ABPM, 18% and 32% of patients demonstrated HTN and prehypertension respectively (18 and 32 of 101, respectively). In univariable modeling, awake and nocturnal systolic BP index ≥ 0.9 on the first ABPM were found to be significantly associated with progression to abnormal ABPM [unadjusted OR (95% CI) awake: 4.3 (1.2 – 14.6); nocturnal: 3.2 (1.0 – 10.1)]; however, these associations were not significant after adjusting for pre-specified covariates [adjusted OR (95% CI) awake: 2.7 (0.7-10.4); nocturnal: 2.6 (0.7 – 9.2)]. Approximately half of children and adolescents first diagnosed with WCH progressed to an abnormal ABPM phenotype on follow-up, suggesting that longitudinal follow-up with ABPM is indicated in pediatric WCH patients. We were unable to identify ABPM findings that might predict a higher risk for progression.

scholarly journals Prevalence of white coat hypertension amongst pregnant women admitted with high BP recordings in ante-natal clinic

2019 ◽  
Vol 8 (11) ◽  
pp. 4141
Author(s):  
Sandeep Sood ◽  
Kuldeep Kumar Ashta ◽  
Sirisha Anne ◽  
Ravi Kumar
Keyword(s):  
Pregnant Women ◽  
Blood Pressure Monitoring ◽  
Age Groups ◽  
Final Diagnosis ◽  
Antenatal Clinic ◽  
White Coat ◽  
White Coat Hypertension ◽  
Long Term Prognosis

Background: White coat hypertension (WCH) is a common and well recognized phenomenon with significant prevalence amongst all age groups. This is also quite prevalent in the pregnant women with an intermediate long term prognosis between hypertensive and normo-tensive individuals. It is important to assess the true prevalence WCH in pregnant women and to prevent unnecessary medications to them during pregnancy but at the same time to keep a timely follow up and a watchful eye on these patients to identify complications at the earliest. Study was conducted at a peripheral secondary level hospital with a small obstetrics and gynecology OPD and ward. 54 patients were diagnosed to be hypertensive in Antenatal Clinic.Methods: All pregnant women who presented to the ANC were screened for hypertension. Those who were diagnosed to be hypertensive in antenatal clinic and these patients were then admitted for Ambulatory Blood Pressure Monitoring (ABPM) for 24 hours.Results: The ABPM tracings were checked and tabulated to arrive at the final diagnosis after 24 hrs. The prevalence of ‘WCH’ in this study was 48.15% as 26/54 patients were found to have their average BP < 140/90 mmHg after measurement by ABPM over 24 hours so they were diagnosed as ‘White Coat Hypertension’ patients.Conclusions: Many women who come to ANC in the early pregnancy are diagnosed to have hypertension. WCH is a well known phenomenon in pregnancy. WCH must be ruled out prior to starting these patients on anti-hypertensive medications.

PROGNOSTIC OF WHITE COAT HYPERTENSION AFTER FIVE YEARS OF FOLLOW-UP: PP.3.106

2010 ◽  
Vol 28 ◽  
pp. e80
Author(s):  
C Santos Moreira ◽  
A Alcântara ◽  
C Alcântara ◽  
V Ramalhinho ◽  
J Braz Nogueira
Keyword(s):  
White Coat ◽  
White Coat Hypertension

Abstract 409: Reproducibility of White Coat and Masked Hypertension Definitions One Year after the Diagnosis

Hypertension ◽  
2014 ◽  
Vol 64 (suppl_1) ◽  
Author(s):  
ALEJANDRO DE LA SIERRA ◽  
JOSE R BANEGAS ◽  
ERNEST VINYOLES ◽  
MANUEL GOROSTIDI ◽  
JULIAN SEGURA ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Antihypertensive Drugs ◽  
White Coat ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Specific Group ◽  
Clinical Pattern ◽  
Prevalence Of Obesity ◽  
One Year

A significant number of subjects present discordant results when BP is measured both at the clinic and by 24-hour ABPM. The aim of the study was to assess the reproducibility of a diagnosis of normotension (NT), white coat hypertension (WCH), masked hypertension (MH) and sustained hypertension (SH) in a cohort of untreated subjects who underwent a second ABPM without being treated with antihypertensive drugs. From the Spanish ABPM Registry, we selected 843 untreated subjects who underwent at least 2 BP examinations (both at the clinic and by ABPM) separated by 2 months or more (median,IQR: 13; 6-28 months), and who did not receive antihypertensive drug treatment in the period lasting between the 2 examinations. The 4 above mentioned categories were defined by normal (<140/90 mmHg) or elevated BP at the clinic (mean of 2 measurements), and by normal (<130/80 mmHg) or elevated 24-hour BP. At baseline, 140 (17%), 206 (25%), 78 (9%), and 414 (49%) had NT, WCH, MH, and SH, respectively. At the 2nd clinic and ABPM examination 52% of NT, 55% of WCH, 47% of MH, and 82% of SH fall into the same category. In both the WCH and MH categories, the most frequent switch was to SH (26% and 33%, respectively). When patients who changed or remained in the same category were compared, there were no differences in clinical variables, such as age, gender, or prevalence of obesity, diabetes, or previous cardiovascular disease. Both clinic and ambulatory BP were higher in patients who fall into the same category in both examinations, but this was driven by the higher reproducibility of SH. In the specific group of WCH (206 patients) there were no significant BP differences at baseline between the 114 who maintained such diagnosis, compared to the 54 patients who developed SH. Conversely, in the 78 patients with MH at baseline, those who developed SH at the 2nd examination (26) had higher levels of clinic diastolic BP (84±4 vs. 80±5 mmHg; p=0.006), compared with those who remained with MH (37). In conclusion, the diagnosis of SH is highly reproducible after one year of the first diagnosis. However, a diagnosis of WCH or MH requires a close follow-up, as almost 50% of patients do not show the same diagnosis and develop SH. There is no a specific clinical pattern which can be of help to predict which patients will develop SH.

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