White coat hypertension
White coat hypertension is a form of resistant hypertension in which the blood pressure is elevated when checked in the medical office but may be normal with ambulatory blood pressure monitoring or automated blood pressure determination[1].
Some patients may have their blood pressure rise by as much as 25 mm Hg due to an alarm reaction upon seeing a doctor (i.e., white coat hypertension).[2]
21% of patients with untreated borderline hypertension (diastolic pressure between 90 and 104 mm Hg) may have normal blood pressures outside of the doctor's office.[3]
White coat hypertension may be associated with:[4]
- "parallels the reactivity to mental stress and standing in hypertensive subjects"
- "likely results from a sympathetic nervous activation via a vasoconstrictor response rather than tachycardia"
- "decreased arterial distensibility"
However, patients with white coat hypertension do not have increased catecholamines.[5]
White coat hypertension may be associated with anxiety (at least in women)[6], obstructive sleep apnea[5], and metabolic syndrome[7].
Although most patients with white coat hypertension are males, a greater proportion of women with hypertension have white coat hypertension than males with hypertension.[3]
Treatment
Because of the association with metabolic syndrome, one treatment option is metformin.[7]
Prognosis
White coat hypertension may evolve into sustained hypertension.[8][9]
Cardiovascular risks may[10] or may not[11] after 10 years of observation.
References
- ↑ Myers MG, Godwin M, Dawes M, Kiss A, Tobe SW, Grant FC et al. (2011). "Conventional versus automated measurement of blood pressure in primary care patients with systolic hypertension: randomised parallel design controlled trial.". BMJ 342: d286. DOI:10.1136/bmj.d286. PMID 21300709. PMC PMC3034423. Research Blogging.
- ↑ Mancia G, Parati G, Pomidossi G, Grassi G, Casadei R, Zanchetti A (1987). "Alerting reaction and rise in blood pressure during measurement by physician and nurse". Hypertension 9 (2): 209–15. PMID 3818018. [e]
- ↑ 3.0 3.1 Pickering TG, James GD, Boddie C, Harshfield GA, Blank S, Laragh JH (1988). "How common is white coat hypertension?". JAMA 259 (2): 225–8. PMID 3336140. [e]
Cite error: Invalid
<ref>tag; name "pmid3336140" defined multiple times with different content - ↑ Lantelme P, Milon H, Gharib C, Gayet C, Fortrat JO (1998). "White coat effect and reactivity to stress: cardiovascular and autonomic nervous system responses.". Hypertension 31 (4): 1021-9. PMID 9535430. [e]
- ↑ 5.0 5.1 García-Río F, Pino JM, Alonso A, Arias MA, Martínez I, Alvaro D et al. (2004). "White coat hypertension in patients with obstructive sleep apnea-hypopnea syndrome.". Chest 125 (3): 817-22. PMID 15006937. [e]
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<ref>tag; name "pmid15006937" defined multiple times with different content - ↑ Carels RA, Sherwood A, Blumenthal JA (1998). "High anxiety and white coat hypertension.". JAMA 279 (3): 197-8. DOI:10.1001/jama.279.3.197. PMID 9438737. Research Blogging.
- ↑ 7.0 7.1 Helvaci MR, Sevinc A, Camci C, Yalcin A (2008). "Treatment of white coat hypertension with metformin.". Int Heart J 49 (6): 671-9. PMID 19075483. [e]
- ↑ Ugajin T, Hozawa A, Ohkubo T, Asayama K, Kikuya M, Obara T et al. (2005). "White-coat hypertension as a risk factor for the development of home hypertension: the Ohasama study.". Arch Intern Med 165 (13): 1541-6. DOI:10.1001/archinte.165.13.1541. PMID 16009871. Research Blogging.
- ↑ Bidlingmeyer I, Burnier M, Bidlingmeyer M, Waeber B, Brunner HR (1996). "Isolated office hypertension: a prehypertensive state?". J Hypertens 14 (3): 327-332. PMID 8723986. [e]
- ↑ Gustavsen PH, Høegholm A, Bang LE, Kristensen KS (2003). "White coat hypertension is a cardiovascular risk factor: a 10-year follow-up study.". J Hum Hypertens 17 (12): 811-7. DOI:10.1038/sj.jhh.1001643. PMID 14704724. Research Blogging.
- ↑ Ohkubo T, Kikuya M, Metoki H, Asayama K, Obara T, Hashimoto J et al. (2005). "Prognosis of "masked" hypertension and "white-coat" hypertension detected by 24-h ambulatory blood pressure monitoring 10-year follow-up from the Ohasama study.". J Am Coll Cardiol 46 (3): 508-15. DOI:10.1016/j.jacc.2005.03.070. PMID 16053966. Research Blogging.