White-coat hypertension: a clinical review

Eur J Intern Med. 2004 Oct;15(6):348-357. doi: 10.1016/j.ejim.2004.08.001.


White-coat hypertension (WCHT), also called 'isolated office or clinic hypertension', is defined as the occurrence of blood pressure (BP) values higher than normal when measured in the medical environment, but within the normal range during daily life, usually defined as average daytime ambulatory BP (ABP) or home BP values (<135 mm Hg systolic and <85 mm Hg diastolic). The prevalence of WCHT varies from 15% to over 50% of all patients with mildly elevated office BP (OBP) values. In untreated hypertensive patients, the probability of WCHT especially increases with female gender and a mildly elevated OBP level. The value of other possible determinants such as (non) smoking status, duration of hypertension, left ventricular mass, number of OBP measurements, educational level, etc. is less consistently shown. Although, for various reasons, studies evaluating the long-term effects of WCHT are not always easy to interpret, most data indicate that persons with WCHT have a worse or equal cardiovascular prognosis than normotensives, but a better one than those with sustained hypertension. WCHT is sometimes considered a prehypertensive state, but data on the long-term evolution of subjects with WCHT are scarce. Patients with WCHT and a high cardiovascular risk or proven target organ damage should be pharmacologically treated. Subjects with uncomplicated WCHT should probably not receive medical therapy, but a close follow-up, including regular assessment of other risk factors and measurement of OBP (every 6 months) and ABP (every 1 or 2 years), is warranted.