Manual blood pressure (BP) recorded in routine clinical practice is relatively inaccurate and associated with higher readings compared to BP measured in research studies in accordance with standardized measurement guidelines. The increase in routine office BP is the result of several factors, especially the presence of office staff, which tends to make patients nervous and also allows for conversation to occur. With the disappearance of the mercury sphygmomanometer because of environmental concerns, there is greater use of oscillometric BP recorders, both in the office setting and elsewhere. Although oscillometric devices may reduce some aspects of observer BP measurement error in the clinical setting, they are still associated with higher BP readings, known as white coat hypertension (for diagnosis) or white coat effect (with treated hypertension). Now that fully automated sphygmomanometers are available which are capable of recording several readings with the patient resting quietly, there is no longer any need to have office staff present when BP is being recorded. Such readings are called automated office blood pressure (AOBP) and they are both more accurate than conventional manual office BP and not associated with the white coat phenomena. AOBP readings are also similar to the awake ambulatory BP and home BP, both of which are relatively good predictors of cardiovascular risk. The available evidence suggests that AOBP should now replace manual or electronic office BP readings when screening patients for hypertension and also after antihypertensive drug therapy is initiated.
Blood Pressure ; Drug Therapy ; Humans ; Hypertension ; Mass Screening ; Reading ; Sphygmomanometers ; White Coat Hypertension

The clinical prognostic importance of white coat hypertension (WCH), that is, the clinical condition characterized by an increase of office but a normal ambulatory or home blood pressure (BP) is since a long time matter of considerable debate. WCH accounts for a consistent portion of hypertensive patients (up to 30–40%), particularly when hypertension is mild or age is more advanced. Although scanty and inconsistent information is available on the response of office and out-office BP to antihypertensive treatment and the cardiovascular (CV) protection provided by treatment, an increasing body of evidence focusing on the association of WCH with CV risk factors, subclinical cardiac and extra-cardiac organ damage and, more importantly, with CV events indicates that the risk entailed by this condition is intermediate between true normotension and sustained hypertension. This review will address a number of issues concerning WCH with particular attention to prevalence and clinical correlates, relation with subclinical target organ damage and CV morbidity/mortality, therapeutic perspectives. Several topics covered in this review are based on data acquired over the past 20 years by the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study, a longitudinal survey performed by our group on the general population living in the surroundings of Milan area in the north part of Italy.
Blood Pressure ; Humans ; Hypertension ; Italy ; Longitudinal Studies ; Prevalence ; Risk Factors ; White Coat Hypertension

BACKGROUND: White coat hypertension is a common finding in hypertensive populations. The phenomenon of white coat hypertension may reflect an abnormally vigorous sympathetic response to the environment of the measurement, especially the presence of the measuring nurse or physician. The author evaluated the magnitude of the white coat effect in elderly white coat hypertensive patients compared to youngers. METHODS: This study included 38 white coat hypertensive patients(20 youngers, 18 olders) between May 2000 and April 2005. All patients had clinic blood pressure> or =140/90mmHg on at least 2 visits and systolic and diastolic 24-hour, daytime, night-time blood pressure and heart rate were recorded. RESULTS: 1) The mean clinic systolic blood pressure was significantly correlated to daytime ambulatory systolic blood pressure(r=0.472, p<0.05) in group A(< or =60 years old) and the mean clinic diastolic blood pressure was significantly correlated to daytime ambulatory diastolic blood pressure(r=0.386, p<0.05) in group B(>60 years old). 2) In group B, daytime ambulatory diastolic blood pressure of male patients was significantly higher than females (male: 77.7+/-5.7mmHg, female: 74.1+/-4.5mmHg, p=0.041). 3) The magnitude of the white coat effect during systolic and diastolic periods was greater in the group B than group A (Group A: 28.9+/-10.4mmHg/13.3+/-7.9mmHg, Group B: 45.8+/-17.4mmHg/18.4+/-8.3mmHg, p>0.001/p=0.041). CONCLUSION: The magnitude of the white coat effect in elderly white coat hypertensive patients was greater than the youngers.
Aged* ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Female ; Heart Rate ; Humans ; Male ; White Coat Hypertension

BACKGROUND: White coat hypertension is a common finding in hypertensive populations. The phenomenon of white coat hypertension may reflect an abnormally vigorous sympathetic response to the environment of the measurement, especially the presence of the measuring nurse or physician. The author evaluated the magnitude of the white coat effect in elderly white coat hypertensive patients compared to youngers. METHODS: This study included 38 white coat hypertensive patients(20 youngers, 18 olders) between May 2000 and April 2005. All patients had clinic blood pressure> or =140/90mmHg on at least 2 visits and systolic and diastolic 24-hour, daytime, night-time blood pressure and heart rate were recorded. RESULTS: 1) The mean clinic systolic blood pressure was significantly correlated to daytime ambulatory systolic blood pressure(r=0.472, p<0.05) in group A(< or =60 years old) and the mean clinic diastolic blood pressure was significantly correlated to daytime ambulatory diastolic blood pressure(r=0.386, p<0.05) in group B(>60 years old). 2) In group B, daytime ambulatory diastolic blood pressure of male patients was significantly higher than females (male: 77.7+/-5.7mmHg, female: 74.1+/-4.5mmHg, p=0.041). 3) The magnitude of the white coat effect during systolic and diastolic periods was greater in the group B than group A (Group A: 28.9+/-10.4mmHg/13.3+/-7.9mmHg, Group B: 45.8+/-17.4mmHg/18.4+/-8.3mmHg, p>0.001/p=0.041). CONCLUSION: The magnitude of the white coat effect in elderly white coat hypertensive patients was greater than the youngers.
Aged* ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Female ; Heart Rate ; Humans ; Male ; White Coat Hypertension

BACKGROUND AND OBJECTIVES: Blood pressure variability (BPV) was recently shown to be a risk factor of stroke. White coat hypertension (WCH) used to be regarded as innocuous, but one long-term follow-up study reported that WCH increased stroke rate compared to normotension (NT). In this study, we aimed to evaluate the relationship between WCH and BPV. SUBJECTS AND METHODS: We analyzed 1398 subjects from the Korean Ambulatory Blood Pressure Registry, who were divided into NT (n=364), masked hypertension (n=122), white coat hypertension (n=254), and sustained hypertension (n=658) groups. RESULTS: Baseline characteristics were similar among groups. The average real variability (ARV), a highly sensitive BPV parameter, was highest in the WCH group, followed by the sustained hypertension, masked hypertension, and NT groups. The results persisted after being adjusted for covariates. The WCH vs. sustained hypertension results (adjusted mean±standard error) were as follows: 24-h systolic ARV, 22.9±0.8 vs. 19.4±0.6; 24-h diastolic ARV, 16.8±0.6 vs. 14.3±0.5; daytime systolic ARV, 21.8±0.8 vs. 16.8±0.6; and daytime diastolic ARV, 16.2±0.6 vs. 13.4±0.5 (p<0.001 for all comparisons). CONCLUSION: From the registry data, we found that subjects with WCH or masked hypertension had higher BPV than NT. However, long-term follow-up data assessing the clinical influences of WCH on stroke are needed.
Blood Pressure Monitoring, Ambulatory* ; Blood Pressure* ; Follow-Up Studies ; Hypertension ; Masked Hypertension ; Risk Factors ; Stroke ; White Coat Hypertension*

BACKGROUND: Many studies have aimed to determine whether body mass index (BMI), waist circumference (WC), or waist to hip ratio (WHR) best predicts hypertension in diabetic patients, with conflicting results. However, no study has examined the specific relationship between these anthropometric parameters with sustained normotension (SNT), white coat hypertension (WCHT), masked hypertension (MHT), and sustained hypertension (SHT) based on office and ambulatory blood pressure (BP) measurements in these patients. METHODS: Patients with newly diagnosed type 2 diabetes underwent the following procedures: history taking, measurements of anthropometric parameters, office and ambulatory BP measurements, physical examination, laboratory analysis, and random and 24-hour urine analysis. RESULTS: In total, there were 65 dippers and 37 nondipper patients. None of the anthropometric parameters were different between the dippers and the nondippers. There were 25 patients with SNT, 32 with WCHT, seven with MHT, and 38 with SHT. A comparison of anthropometric parameters between these four groups of patients showed that WC (P=0.016) and WHR (P=0.015) were different among all groups. According to regression analysis, only BMI was independently related with MHT (odds ratio [OR], 1.373, P=0.022), whereas only WC has been associated with SHT (OR, 1.321, P=0.041). CONCLUSION: Among anthropometric parameters, only WC and WHR were different in SNT, WCHT, MHT, and SHT in newly diagnosed patients with type 2 diabetes.
Blood Pressure ; Body Mass Index ; Humans ; Hypertension ; Masked Hypertension ; Masks ; Physical Examination ; Waist Circumference ; Waist-Hip Ratio ; White Coat Hypertension

This review represents the clinical significance of home blood pressure (BP) and its possible practical application. Home BP is highly reproducible and its reproducibility is better than ambulatory BP. According to this feature home BP has a greater prognostic value at least than clinic BP and is extremely effective for the evaluation of drug effects and their duration. The introduction of home BP to the diagnosis and treatment of hypertension facilitates long-term BP control. Home BP is particularly important for the diagnosis and treatment of hypertension in diabetes mellitus, pregnancy, children and renal diseases. Home BP measurements improve the adherence to medications and medical consultations, and are indispensable for diagnosis of white coat hypertension and masked hypertension. Such efficiency of home BP improves medical economy. Home BP can detect minimal charge in BP mediated by medication, and intrinsic and extrinsic stimuli and detect long-term change in BP. Thus, home BP is now indispensable for improvement in the management of hypertension in medical practice as well as for the recognition of hypertension in the general population. Standardization of the measurement procedure may elevate the position of home BP in the practice of diagnosing and treating hypertension.
Blood Pressure ; Child ; Diabetes Mellitus ; Fees and Charges ; Humans ; Hypertension ; Masked Hypertension ; Pharmacology, Clinical ; Pregnancy ; Referral and Consultation ; White Coat Hypertension

BACKGROUND: White coat effect (WCE) and white coat hypertension (WCH) are relatively prevalent in clinical situation (20 - 57% of WCH in the hypertensive population). The aim of this study was to analyze the determinant factors of WCE. METHODS: A prospective study was carried out in outpatient clinic in a consecutive hypertensives without receiving pharmacologic treatment. Twenty-four hour ambulatory blood pressure monitoring (ABPM) was performed following more than two resting blood pressure (BP) determinations carried out with the interval of 1 - 2 weeks by mercury sphygmomanometer. WCE was calculated for systolic and diastolic BP as the difference between a clinic BP (CBP) and an average daytime ambulatory BP (ABP). WCH was defined as;BP in the clinic > or = 140/90 mmHg with a mean daytime BP by ABPM < or =137/< or =89 mmHg. RESULTS: 1) Two hundred thirty-five patients (mean age 49.7 years, females 74%) were studied. Thirty-seven percent in male and forty-six percent in female patients fulfilled WCH criteria. 2) CBP was significantly correlated to daytime ABP (systolic BP;r=.47, p<.001 and diastolic BP;r=.65, p<.001). 3) The magnitude of WCE was greater in the group of WCH (28.9+14.6/19.3+6.9 mmHg) than ambulatory hypertensives (15.1+15.7/13.0+8.2 mmHg) (p<.001). 4) The magnitude of WCE is significantly correlated with female (r2=.12, p<.001) and the stage of CBP according to JNC-V (r2=.23, p<.001) in systolic BP, the stage (r2=.08, p<.001) in diastolic BP, and the stage (r2=.09, p<.001) and weight (r2=.15, p<.01) in mean BP. CONCLUSIONS: The magnitude of WCE in essential hypertension diagnosed at the clinic is significantly correlated with female, the magnitude of clinic BP, and weight.
Ambulatory Care Facilities ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Female ; Humans ; Hypertension* ; Male ; Prospective Studies ; Sphygmomanometers ; White Coat Hypertension

BACKGROUND: This study compared the results of 24 hour ambulatory blood pressure monitoring with the clinical blood pressure measurements, and we investigated the relationship of the blood pressure measurement and left ventricular hypertrophy, as determined by routine 12 lead electrocardiography. METHODS: We studied 204 healthy adults with no prior history of heart disease or antihypertensive medication. The clinic blood pressure was measured 3 times and the average was taken. We compared the clinic blood pressure with the daytime blood pressure of the 24 hour ambulatory blood pressure monitoring, and we compared the blood pressure with the sum of the voltage of the S wave on V1 and the R wave on V5. RESULTS: The average of the daytime ambulatory blood pressure of all the patients was 135.33+/-13.73 mmHg for the systolic pressure and 86.55+/-10.14 mmHg for the diastolic pressure. The average of the clinic blood pressure measurement was 140.10+/-17.41 mmHg for the systolic pressure and 88.84+/-10.14 mmHg for the diastolic pressure. The clinic blood pressure averaged higher than the daytime ambulatory blood pressure by 5 mmHg on the systolic pressure and 2 mmHg on the diastolic pressure (p<0.001). The normal ambulatory blood pressure limits were estimated as those that best correlated with 140/90 mmHg at the clinic. The estimated value was 135/87 mmHg for the daytime ambulatory blood pressure (p+/-0.001). The incidence of white coat hypertension was 10.8%. The sum of the voltage on electrocardiography showed a positive linear relationship with all the blood pressure measurements. The daytime systolic blood pressure showed the strongest correlation with the 24 hour ambulatory blood pressure monitoring (r=0.283, p+/-0.001). CONCLUSIONS: We found a linear relation and we analyzed the differences between the clinical and 24 hour ambulatory blood pressure. A daytime ambulatory blood pressure value of 135/87 mmHg was a suitable upper normal limit for the corresponding cutoff value of the clinic blood pressure. Left ventricular hypertrophy showed the strongest relationship with the daytime systolic blood pressure among the results of the 24 hour ambulatory blood pressure monitoring.
Adult ; Blood Pressure Monitoring, Ambulatory ; Blood Pressure* ; Electrocardiography* ; Heart Diseases ; Humans ; Hypertension ; Hypertrophy, Left Ventricular* ; Incidence ; White Coat Hypertension

BACKGROUND: The use of ambulatory blood pressure monitoring (ABPM) in childhood hypertension has been in great advance. ABPM has been able to detect significantly high blood pressure (BP) and also helpful for identifying white coat hypertension. METHODS: Between March 2007 and December 2009, we evaluated individuals aged from 7 to 19 years who were referred as high BP with ABPM, echocardiogram, and abdominal computerized tomography, calculation of body mass index (BMI) at Ajou University Hospital. ABPM was performed using the Tonoport V monitors and SpaceLab 90217 monitors. Seventy were evaluated with 55 boys and 5 girls. The mean age of them was 13.1 +/- 2.8 years (mean +/- standard deviation). RESULTS: Forty of seventy (57.1%) were diagnosed as hypertension in ABPM and 8 of 40 were diagnosed as secondary hypertension with underline diseases such as hyperthyroidism, chronic renal disease, Takayasu's arteritis, coarctation of aorta. The mean BMI in 40 was 24.8 +/- 4.72 kg/m2. Twenty-three of seventy (32.8%) were obese with higher prevalence than in general population. White coat hypertension was diagnosed in 30 of 70 (42.9%). CONCLUSIONS: ABPM could provide more detailed data including mean values of BP, load, and night dip in assessment of children's BP. According to increasing children's obesity, use of ABPM was thought to be necessary for evaluation of their risk of hypertension and useful for diagnosis of masked hypertension and white coat hypertension. Further more study of ABPM in children and adolescents would be needed for absolute standards of ABPM.
Adolescent ; Aged ; Aortic Coarctation ; Blood Pressure Monitoring, Ambulatory ; Body Mass Index ; Child ; Humans ; Hypertension ; Hyperthyroidism ; Masked Hypertension ; Obesity ; Prevalence ; Renal Insufficiency, Chronic ; Takayasu Arteritis ; White Coat Hypertension