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. 2003 Oct;53(495):790–793.

Predictors for the white coat effect in general practice patients with suspected and treated hypertension.

Morten Lindbaek 1, Endre Sandvik 1, Kåre Liodden 1, Johnny Mjell 1, Kai Ravnsborg-Gjertsen 1
PMCID: PMC1314712  PMID: 14601355

Abstract

BACKGROUND: Ambulatory blood pressure monitoring was introduced more than 40 years ago and is accepted as a clinically useful method to evaluate the white coat effect in patients with suspected and established hypertension. AIM: To study the differences between blood pressure readings taken in the physician's office in the primary healthcare setting, and ambulatory readings, and to find possible predictors. DESIGN OF STUDY: Prospective study. SETTING: Two primary healthcare centres in Norway. METHOD: The study included 221 patients, 107 of whom were on antihypertensive treatment, and 114 of whom were under investigation for possible hypertension. Differences between blood pressure readings taken in the physician's office and ambulatory readings were calculated. Independent predictors for the white coat effect were calculated using linear regression analysis. RESULTS: The difference between blood pressure readings taken in the office and ambulatory readings was 27 mmHg systolic and 11 mmHg diastolic. For the systolic readings, the following factors were independent predictors of the amount of the white coat effect: mean blood pressure, age, history of smoking, family history of cardiovascular disease, and antihypertensive treatment. For the diastolic readings, they were: mean blood pressure, history of smoking, and sex of the patient (with this being most significant for women). CONCLUSION: Ambulatory blood pressure measurement is of significant value in identifying patients with white coat hypertension. It can be an important supplement for use in the diagnosis and follow-up of patients with hypertension in general practice.

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Selected References

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  1. Anderson K. M., Odell P. M., Wilson P. W., Kannel W. B. Cardiovascular disease risk profiles. Am Heart J. 1991 Jan;121(1 Pt 2):293–298. doi: 10.1016/0002-8703(91)90861-b. [DOI] [PubMed] [Google Scholar]
  2. Dyrdal Audun, Lindbaek Morten. Diagnostikk av hypertensjon i allmennpraksis--er kontorblodtrykk tilstrekkelig? Tidsskr Nor Laegeforen. 2003 Jan 23;123(2):147–151. [PubMed] [Google Scholar]
  3. Hansson L., Hedner T., Himmelmann A. The 1999 WHO-ISH Guidelines for the Management of Hypertension--new targets, new treatment and a comprehensive approach to total cardiovascular risk reduction. Blood Press Suppl. 1999;1:3–5. [PubMed] [Google Scholar]
  4. Little Paul, Barnett Jane, Barnsley Lucy, Marjoram Jean, Fitzgerald-Barron Alex, Mant David. Comparison of agreement between different measures of blood pressure in primary care and daytime ambulatory blood pressure. BMJ. 2002 Aug 3;325(7358):254–254. doi: 10.1136/bmj.325.7358.254. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Loeken K., Steine S., Sandvik L., Laerum E. A new instrument to measure patient satisfaction with mammography. Validity, reliability, and discriminatory power. Med Care. 1997 Jul;35(7):731–741. doi: 10.1097/00005650-199707000-00006. [DOI] [PubMed] [Google Scholar]
  6. Mancia G., Parati G. The role of ambulatory blood pressure monitoring in elderly hypertensive patients. Blood Press Suppl. 2000;2:12–16. [PubMed] [Google Scholar]
  7. Mancia G., Sega R., Bravi C., De Vito G., Valagussa F., Cesana G., Zanchetti A. Ambulatory blood pressure normality: results from the PAMELA study. J Hypertens. 1995 Dec;13(12 Pt 1):1377–1390. [PubMed] [Google Scholar]
  8. Mann S., Millar Craig M. W., Raftery E. B. Superiority of 24-hour measurement of blood pressure over clinic values in determining prognosis in hypertension. Clin Exp Hypertens A. 1985;7(2-3):279–281. doi: 10.3109/10641968509073547. [DOI] [PubMed] [Google Scholar]
  9. Mengden T., Bättig B., Vetter W. Self-measurement of blood pressure improves the accuracy and reduces the number of subjects in clinical trials. J Hypertens Suppl. 1991 Dec;9(6):S336–S337. [PubMed] [Google Scholar]
  10. O'Brien E., Coats A., Owens P., Petrie J., Padfield P. L., Littler W. A., de Swiet M., Mee F. Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British hypertension society. BMJ. 2000 Apr 22;320(7242):1128–1134. doi: 10.1136/bmj.320.7242.1128. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Pickering T. G. Blood pressure measurement and detection of hypertension. Lancet. 1994 Jul 2;344(8914):31–35. doi: 10.1016/s0140-6736(94)91053-7. [DOI] [PubMed] [Google Scholar]
  12. Spence J. D. Withholding treatment in white-coat hypertension: wishful thinking. CMAJ. 1999 Aug 10;161(3):275–276. [PMC free article] [PubMed] [Google Scholar]
  13. Verdecchia P., Porcallati C. Prognostic value of ambulatory blood pressure monitoring. J Hypertens. 1995 Mar;13(3):373–374. [PubMed] [Google Scholar]
  14. Verdecchia P. Prognostic value of ambulatory blood pressure : current evidence and clinical implications. Hypertension. 2000 Mar;35(3):844–851. doi: 10.1161/01.hyp.35.3.844. [DOI] [PubMed] [Google Scholar]
  15. Verdecchia P., Schillaci G., Borgioni C., Ciucci A., Porcellati C. Prognostic significance of the white coat effect. Hypertension. 1997 Jun;29(6):1218–1224. doi: 10.1161/01.hyp.29.6.1218. [DOI] [PubMed] [Google Scholar]
  16. Verdecchia P., Staessen J. A., White W. B., Imai Y., O'Brien E. T. Properly defining white coat hypertension. Eur Heart J. 2002 Jan;23(2):106–109. doi: 10.1053/euhj.2001.2657. [DOI] [PubMed] [Google Scholar]
  17. de Gaudemaris R., Chau N. P., Mallion J. M. Home blood pressure: variability, comparison with office readings and proposal for reference values. Groupe de la Mesure, French Society of Hypertension. J Hypertens. 1994 Jul;12(7):831–838. [PubMed] [Google Scholar]

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