Is white coat hypertension for real?

Are you a white-coat hypertensive?

White-coat hypertension is a type of blood pressure (BP) problem that occurs only when BP is measured in a clinical setting, e.g. by health professional in a “white coat”. However, BP measured at home or in another environment stays normal. Unlike “real” hypertension, white-coat hypertension has always been dismissed as harmless and psychosomatic in nature. This led to white-coat hypertensives being ignored as hypochrondriacs who do not need any therapy.

Recent studies, however, indicate that white coat hypertension may actually be a real blood pressure disorder with the similar dangers and risks as chronic hypertension.

A study by Glasgow researchers showed that white-coat hypertensives have similar cardiovascular abnormalities as chronic hypertensives. These abnormalities include reduced elasticity of the arterial walls and left ventricular diastolic dysfunction.

According to these researchers,

“these early changes may precede systolic dysfunction and, ultimately, the development of cardiac failure.”

A more recent study by Italian researchers also indicates that this type of hypertension has similar vascular impact as the other more dreaded type pf hypertension and may induce atherosclerosis of the carotid arteries.

The Italian researchers measured 24-hour ambulatory blood pressure in 74 patients with grade I hypertension during a normal working day. The patients were young adults aged 18 to 45 years old.

After 5 years of follow-up, the researchers observed that the carotid arteries of these white coat hypertensive patients were thicker than their counterparts with normal blood pressure.

“…the patients’ average carotid intima-media thickness (IMT) increased 3.4-fold, and significantly more than the corresponding increase in 20 normotensive controls.”

Some experts think that white-coat hypertension may be a form of stress-reactive hypertension. Some patients, for example, have different blood pressure measurements depending on environmental conditions, not necessarily in relation to the presence of a health care professional. There is also a form of hypertension that manifests only during office hours in people with normal blood pressure during daytime non-working hours.

Whatever the mechanisms are behind this fluctuation in BP, white coat hypertension has been linked to progression of atherosclerosis and left ventricular mass.”

The treatment of white coat hypertensive hasn’t always been clearly defined. In many cases, it was taken as a harmless condition which does not require any form of anti-hypertensive therapy. The patients are spared of the cost of health care as well as the unnecessary side effects of hypertensive drugs.

Researchers, however, argue that

“…white-coat hypertensives should not be regarded as having a benign condition, because it may increase susceptibility to vascular complications early in life.”

They recommend that early intervention using drug therapy may delay or prevent the development of cardiovascular complications that may prove life-threatening.

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