White Coat Hypertension: How Dangerous Is It?

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.

NEXT: How dangerous is WCH?

Not always benign

A 2018 study published in The New England Journal of Medicine raised eyebrows when it found that patients with WCH were at an increased risk of all-cause death when compared with normotensive patients. The study also found that WCH was not associated with as great a mortality risk as masked hypertension, a condition in which the patient’s BP is lower in the clinic than at home.³

The study was the largest to date -approximately 60 000 people-of clinic vs ambulatory BP monitoring, but it was not without flaws.

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