From the Guidelines
White coat syndrome is a real condition that affects approximately 10-30% of people diagnosed with high blood pressure, where blood pressure readings are higher in a medical setting compared to readings taken at home. This phenomenon occurs due to anxiety or stress triggered by being in a healthcare environment, causing the body to release hormones like adrenaline, which temporarily raise blood pressure 1. The condition is characterized by elevated blood pressure readings in the office, but normal readings at home or with ambulatory blood pressure monitoring.
Key Points to Consider
- White coat hypertension is associated with a minimal to slightly increased risk of cardiovascular disease (CVD) and all-cause mortality risk, as stated in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.
- The incidence of white coat hypertension converting to sustained hypertension is 1% to 5% per year, with a higher incidence of conversion in those with elevated blood pressure, older age, obesity, or black race 1.
- To manage white coat syndrome, doctors may recommend home blood pressure monitoring, ambulatory blood pressure monitoring, or relaxation techniques before measurements, as suggested in the 2020 International Society of Hypertension Global Hypertension Practice Guidelines 1.
Importance of Accurate Diagnosis
It's essential to identify white coat syndrome to avoid unnecessary medication or treatment for hypertension when a person's blood pressure is actually normal in everyday settings. However, even if you have white coat syndrome, consistently elevated readings should still be discussed with your healthcare provider, as they may indicate an underlying risk for developing sustained hypertension over time. Annual ambulatory blood pressure monitoring or home blood pressure monitoring is recommended to detect progression or masked hypertension 1.
From the Research
Definition and Prevalence of White Coat Syndrome
- White coat syndrome, also known as white coat hypertension, is a condition where a person's blood pressure is higher when measured in a medical setting than when measured in a non-medical setting or at home 2, 3, 4.
- The prevalence of white coat hypertension varies from 15% to over 50% of all patients with mildly elevated office blood pressure values 4.
- Studies have shown that white coat hypertension is more common in women and in patients with mildly elevated office blood pressure levels 4.
Characteristics and Diagnosis of White Coat Syndrome
- White coat syndrome is characterized by an elevation of blood pressure in the first or last hour of ambulatory blood pressure monitoring, with a mean daytime pressure of less than 135 mm Hg/85 mm Hg 2.
- The white coat effect is essentially systolic, with pure diastolic white coat hypertension being exceedingly rare 5.
- Ambulatory blood pressure monitoring is a useful tool for diagnosing white coat syndrome, as it can detect the elevation of blood pressure in the first or last hour of monitoring 2, 3.
Clinical Impact and Treatment of White Coat Syndrome
- White coat syndrome is associated with a worse or equal cardiovascular prognosis than normotensives, but a better one than those with sustained hypertension 4.
- Patients with white coat hypertension and a high cardiovascular risk or proven target organ damage should be pharmacologically treated, while those with uncomplicated white coat hypertension should receive close follow-up and regular assessment of other risk factors 4.
- The development of target organ damage and increased cardiovascular risk play different roles in the different subgroups of white coat syndrome, including white coat hypertension, white coat effect, and masked hypertension 6.