-While the white coat effect is commonly defined as office pressures 20/10 mm Hg greater than out-of-office readings, this paper illustrates that the effect can be much more pronounced. For example, clinic readings resulted in some controlled hypertensives being labeled as suffering from stage 2 (
≥160/100 mm Hg) hypertension.
-As such, among patients who don't carry the diagnosis of hypertension and have no evidence of end organ damage (renal, cardiac, cerebrovascular complications), one can't assume an elevated office reading is simply "too high" to be attributed to the White Coat Syndrome. Instead, the diagnosis should be confirmed with
or 24 hour ambulatory monitoring.
-Among those with documented hypertension, out-of-office readings should also be obtained to document uncontrolled BP prior to prescribing additional agents.
-Limitations: If study physicians were educated on the appropriate technique for measuring BP, the white coat effect would have been minimized. However, this study highlights real-world practice patterns; moreover, institution of and ongoing adherence to correct technique remains difficult.
-N.B.:Thanks to Dr. Jan Basile for his assistance with this issue.