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White Coat Hypertension

News and Research:

• The blood pressure readings you get at the doctor’s office may not be so accurate - Washington Post, 4/25/21 - "A study of people who took part in the Systolic Blood Pressure Intervention Trial (SPRINT) found that blood pressure readings taken during routine clinic appointments were consistently higher than those taken during the study’s trial, which carefully adhered to AHA guidelines ... The U.S. Preventive Services Task Force, an independent body of medical experts in prevention and evidence-based medicine, found in 2015 that 15 to 30 percent of people with high blood pressure readings at routine clinic appointments may have lower readings outside of that setting ... There can be several explanations, including that some patients feel anxious at the doctor’s office — they experience the “white-coat syndrome” — which can cause a high reading. And others may have rushed to get to their appointment, navigating subways, traffic and parking without time to calm down before blood pressure is taken. But it’s also clear, experts say, that some clinics just aren’t doing it right."
• High Blood Pressure at Doctor's Could Signal Danger - WebMD, 6/10/19 - "People who had untreated white-coat hypertension had double the risk of dying from heart disease or stroke compared with people with normal blood pressure ... Besides looking at white-coat hypertension, the review also looked at white-coat effect. This is when elevated in-office blood pressure is treated with medication. The concern is that if readings are only elevated in the doctor's office, high blood pressure drugs might drop pressure too low ... But researchers didn't find any significant links between white-coat effect and heart disease and strokes, or deaths from heart disease and strokes, or deaths from any cause" - Note:  The article seems to contradict itself.
• Doctors raise blood pressure in patients - Science Daily, 3/25/14 - "recordings taken by doctors are significantly higher (by 7/4mmHg) than when the same patients are tested by nurses"
• White Coat Hypertension in the Very Elderly: Worth Treating? - Medscape, 2/28/13 - "We should not ignore patients who say that their blood pressures at home are not high, so we do not need to treat them, because white coat hypertensives in this elderly age group benefited just as much as people who had ambulatory monitoring elevations"
• 'White Coat Effect' Linked to Hypertension Overtreatment - WebMD, 6/21/11 - "the stress of a medical exam can cause large elevations in blood pressure ... the new research highlights the largely unrecognized risk of treating patients too aggressively based on falsely high blood pressure readings"

Abstracts:

• Treatment of white coat hypertension with metformin - Int Heart J. 2008 Nov;49(6):671-9 - "White coat hypertension (WCH) is most likely a disorder associated with metabolic syndrome ... Twenty-five cases (14.7%) stopped metformin therapy due to excessive anorexia. At the end of a 6-month period, there were highly significant differences between the two groups with respect to the prevalences of resolved WCH, hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, overweight and obesity, and decreased fasting plasma glucose below 110 mg/dL ... Thus, the management of WCH should not focus solely on the regulation of blood pressure with antihypertensive medications, but rather on the prevention of future excess weight and various associated disorders, and metformin alone is an effective therapeutic option, most likely due to its powerful inhibitory effect on appetite"
• Can blood pressure measurements taken in the physician's office avoid the 'white coat' bias? - Blood Press Monit. 2011 Sep 3 - "physician's clinic (CBP) ... ambulatory (ABP) and home (HBP) monitoring ... nonclinical setting by trained technicians (NCBP) ... Multiple regression analysis showed that HBP and NCBP (P<0.001) explained 94 and 87% of the variance in systolic and diastolic ABP, respectively. The agreement between NCBP and ABP was greater than that between CBP and ABP or between HBP ... When ABP monitoring and HBP monitoring are not options, the NCBP at the clinic can avoid the white coat bias and therefore improve diagnosis"