Visiting a doctor can be stressful and, for some patients, the experience is so stressful that their blood pressure (BP) spikes at the mere sight of a medical professional. Patients who have normal BP readings at home but have apparent hypertension when in their doctors’ offices are said to have white coat hypertension (WCH).
White coat hypertension was first mentioned in the literature in 1896 by Scipione Riva-Rocci, better known as the inventor of the modern sphygmomanometer.1 The term itself was coined in the next century by Thomas Pickering.2 Diagnostic criteria for hypertension vary, but it is likely that anywhere from 30% to 40% of patients experience WCH.2
Historically, the condition itself has been considered benign. The risk was from overmedicating patients who, though presenting with elevated BP in the office, did not have elevated readings when not in the clinic and could therefore be harmed by aggressive treatment.
Recent studies, however, suggest that the syndrome itself might not be as benign as previously thought.
1. Cobos B, Haskard-Zolnierek K, Howard K. White coat hypertension: Improving the patient-health care practitioner relationship. Psychol Res Behav Manag. 2015;8:133-141.
2. Franklin SS, Thijs L, Hansen TW, O'Brien E, Staessen JA. White-coat hypertension: new insights from recent studies. Hypertension. 2013;62:982-987.
3. Banegas JR, Ruilope LM, de la Sierra A, et al. Relationship between clinic and ambulatory blood-pressure measurements and mortality. N Engl J Med. 2018;378:1509-1520.
4. Cohen JB, Lotito MJ, Trivedi UK, et al. Cardiovascular events and mortality in white coat hypertension: A systematic review and meta-analysis. Ann Intern Med. 2019;170:853-862.