Cardiovascular Risk Associated With White-Coat HypertensionResponse to Cardiovascular Risk Associated With White-Coat Hypertension:Con Side of the Argument
Con Side of the Argument
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Building on the work of Mann et al1 at Northwick Park Hospital in London, Coats et al2 at the John Radcliffe Hospital in Oxford, and Perloff et al3 at the San Francisco Medical Center, in 1988, Thomas Pickering coined the term white-coat hypertension, to describe patients whose blood pressure was elevated in the medical environment, but not during daytime ambulatory monitoring.4,5 Early pioneering studies1–3 unambiguously established that ambulatory blood pressure is a better predictor of cardiovascular outcome than the in-office blood pressure and consequently surmised that white-coat hypertension must be associated with low cardiovascular risk. A seminal article by Pickering et al4 included a statement that patients who showed an exaggerated response to the clinic environment might also exhibit a similar response to more regularly occurring types of stress, which could support the continued use of clinic blood pressure for making therapeutic decisions. However, observations by Pickering et al4 did not support this preposition.
The first longitudinal study on the prognostic values of white-coat hypertension was reported in 1994.6 On the basis of these early studies1–6 and confirmatory reports in patients7 and populations,8–12 the currently prevailing point of view is that white-coat hypertension carries little cardiovascular risk.13 However, some researchers14 suggested that white-coat hypertension is a heterogeneous condition. In making this statement, they did not refer to the loose criteria in the literature used to diagnose white-coat hypertension. They alluded to the fact that in some studies, white-coat hypertension, compared with true normotension, was associated with a higher prevalence of cardiovascular risk factors and target organ damage,15 increased mortality,15 more cardiovascular events,16 and higher out-of-the-office blood pressure.15,16 In this article, we will demonstrate …