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Hypertension
Published in Henry J. Woodford, Essential Geriatrics, 2022
White coat effect is a term used to describe a pattern of hypertension with initial high readings in the presence of a healthcare professional (historically a doctor – hence ‘white coat') but lower BP values are then detected on ABPM (i.e. a discrepancy > 20/10 mmHg).13 It is estimated to occur in 15–30% of the population but is more common in older people. Its significance is not fully understood. It is represented in Figure 18.3. White coat hypertension should be suspected in people who continue to have high BP readings despite treatment for hypertension but also experience symptoms that suggest over-treatment (e.g. postural lightheadedness).
Identifying cases of disease: Clinimetrics and diagnosis
Published in Milos Jenicek, Foundations of Evidence-Based Medicine, 2019
Is it important for us to better understand if and how our diagnosis is influenced by the context in which it is made? Definitely. The ‘white coat hypertension’, i.e. where blood pressure is persistently higher in the presence of a doctor or nurse, but normal outside the medical setting140 illustrates how our findings depend on the setting in which they are made.
2018 ESC/ESH Guidelines for the Management of Arterial Hypertension
Published in Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei, Manual of Hypertension of the European Society of Hypertension, 2019
Bryan Williams, Giuseppe Mancia, Wilko Spiering, Enrico Agabiti Rosei, Michel Azizi, Michel Burnier, Denis L. Clement, Antonio Coca, Giovanni de Simone, Anna F. Dominiczak, Thomas Kahan, Felix Mahfoud, Josep Redon, Luis M. Ruilope, Alberto Zanchetti, Mary Kerins, Sverre E. Kjeldsen, Reinhold Kreutz, Stéphane Laurent, Gregory Y.H. Lip, Richard McManus, Krzysztof Narkiewicz, Frank Ruschitzka, Roland E. Schmieder, Evgeny Shlyakhto, Konstantinos P. Tsioufis, Victor Aboyans, Ileana Desormais
HMOD is less prevalent in white-coat hypertension than in sustained hypertension, and recent studies show that the risk of cardiovascular events associated with white-coat hypertension is also lower than that in sustained hypertension [68,85,86]. Conversely, compared with true normotensives, patients with white-coat hypertension have increased adrenergic activity [87], a greater prevalence of metabolic risk factors, more frequent asymptomatic cardiac and vascular damage, and a greater long-term risk of new-onset diabetes and progression to sustained hypertension and LVH [82]. In addition, although the out-of-office BP values are, by definition, normal in white-coat hypertension, they tend to be higher than those of true normotensive people, which may explain the increased long-term risk of cardiovascular events reported in white-coat hypertension by recent studies after adjustment for demographic and metabolic risk factors [85,86,88–90]. White-coat hypertension has also been shown to have a greater cardiovascular risk in isolated systolic hypertension and older patients [91], and does not appear to be clinically innocent [68]. The diagnosis should be confirmed by repeated office and out-of-office BP measurements, and should include an extensive assessment of risk factors and HMOD. Both ABPM and HBPM are recommended to confirm white-coat hypertension, because the cardiovascular risk appears to be lower (and close to sustained normotension) in those in whom both ABPM and HBPM are both normal [82]; for treatment considerations (see section ‘White-coat hypertension’).
Masked hypertension in type 2 diabetes: never take normotension for granted and always assess out-of-office blood pressure
Published in Blood Pressure, 2022
Krzysztof Narkiewicz, Sverre E. Kjeldsen, Brent M. Egan, Reinhold Kreutz, Michel Burnier
Traditionally, the diagnosis of hypertension was based on office blood pressure (BP) measurements. BP status was defined as a binary: your patient was either normotensive or hypertensive. Introduction of ambulatory BP monitoring revealed that the picture is much more complex than we initially thought. Consequently, current European recommendations [1,2] recognise four BP categories: true normotension, sustained hypertension, white-coat hypertension and masked hypertension. The term ‘true normotension’ is used when both office and out-of-office measurements are concordant within normal limits, and ‘sustained hypertension’ is diagnosed when both values are elevated. White-coat hypertension refers to the untreated condition in which BP is elevated in the office, but is normal when assessed by ambulatory BP monitoring and/or home BP measurements. Conversely, masked hypertension is diagnosed in subjects whose BP is normal in the office, but is elevated on out-of-office measurements.
Immunomodulatory properties of antihypertensive drugs and digitalis glycosides
Published in Expert Review of Cardiovascular Therapy, 2022
Paweł Bryniarski, Katarzyna Nazimek, Janusz Marcinkiewicz
European guidelines (The European Society of Cardiology and European Society of Hypertension (ESC/ESH), and the National Institute for Health and Care Excellence) define hypertension as systolic pressure ≥140 mmHg and/or diastolic pressure ≥90 mmHg (using office-based blood pressure) [1]. It also happens that the patient has fluctuations in pressure in certain situations, e.g. in a doctor’s office. We define white coat hypertension as blood pressure that is continuously elevated during measurements in the office but does not meet the diagnostic criteria for hypertension if we assess pressure outside the office. The inverse of white coat hypertension is masked hypertension. We define it as blood pressure that is constantly elevated when measured outside the office but does not meet the criteria for hypertension based on measurements at the doctor’s office.
Unattended automated office blood pressure in living donor kidney transplant recipients
Published in Blood Pressure, 2021
Minh Ngoc Nguyen, Karin Skov, Birgitte Bang Pedersen, Niels Henrik Buus
The studies mentioned above used office BP performed by a doctor or nurse directly confronting the patient which is suspected to increase BP in some individuals resulting in white coat hypertension. However, it may not be the confrontation per se that makes the BP increase. In a cohort of patients with chronic kidney disease (CKD), we have previously shown that the average office BP level is similar when the measurement is performed by a nurse or actively by the patient him or herself [32]. Both in the study by Tougaard et al. and in a former investigation in CKD patients using BpTru, there was a drop in systolic BP from the first to the last measurement of 5–7 mmHg suggesting similar patient relaxation [15,32]. An important advantage of AOBP recordings is the lack of information to the patient about the BP readings during the actual measuring period. This will potentially make the patient relax better. Furthermore, AOBP measurements refrain the patients from accidentally or deliberately reporting erroneous BP values [33]. Still, BpTru and other automatic BP devices performing repeated measurements have only been sparsely evaluated in KTRs and whether this population reacts differently from other patients to repeated cuff inflations is unknown. However, ÓShaughnessy et al. reported a similar difference between BpTRU and conventional office BP recordings for KTRs and non-transplanted CKD patients [34].