Do You Have White Coat Hypertension?
Do you have white coat hypertension?
Your top question about blood pressure, answered!
White coat hypertension is when someone has elevated blood pressure at their doctors office, but normal blood pressure readings when measured outside of the office with either ABPM (ambulatory BP monitoring) or HBPM (home BP monitoring).
White coat effect (usually considered clinically significant when office SBP/DBPs are >20/10 mmHg higher than home blood pressure, has been implicated in “pseudo-resistant hypertension” and results in an underestimation of office blood pressure control rates.
White coat hypertension prevalence averages approximately 13%, and as high as 35% in some hypertensive populations. Prevalence of white coat hypertension is higher with increasing age, female, non smoking, and routine office BP measurements. Many, but not all, studies have identified a minimal increase in risk of cardiovascular disease complications in patients with white coat hypertension.
So how do we evaluate you for white coat hypertension?
In adults with an untreated systolic blood pressure> 130 but less than 160, or diastolic blood pressure greater than 80, but less than 100, it is reasonable to screen for the presence of white coat hypertension by evaluating their blood pressure at home (using ABPM or HBPM), before giving them a diagnosis of hypertension.
Only 20–30% of these patients will have home blood pressure monitoring which demonstrates their blood pressure is actually <130/80. These individuals have white coat hypertension. For white coat hypertension, we recommend lifestyle modification and periodic monitoring of home blood pressure, to detect transition to sustained hypertension. Up to 5% of people per year with white coat hypertension will actually convert to having sustained hypertension.
70–80% of these patients will have home blood pressure monitoring which demonstrates their blood pressure is actually >130/80. These individuals have true hypertension, and will require lifestyle change plus they may potentially need medical therapy.
Well then, what is considered high blood pressure?
According to the 2018 ACC/AHA Blood Pressure Guidelines Classification of Hypertension:
Normal Blood Pressure: Systolic Blood Pressure <120 and Diastolic Blood Pressure <80
Elevated Blood Pressure: Systolic Blood Pressure 120–129 and Diastolic Blood Pressure <80
Stage 1 Hypertension: Systolic Blood Pressure 130–139 *or* Diastolic Blood Pressure 80–89
Stage 2 Hypertension: Systolic Blood Pressure > or = 140 *or* Diastolic Blood Pressure > or = 90
Monitoring your blood pressure at home, can help both you, and your physician, optimize your health and treatment plan.
Dr. Belardo is a cardiologist in a multidisciplinary practice in Newport Beach, California. Dr. Belardo sees patients for cardiovascular disease, preventive cardiology, advanced lipidology, cardiometabolic health, and weight loss. She is the co-chair of the American Society of Preventive Cardiology Nutrition Committee, a member of the American College of Cardiology Nutrition and Lifestyle Committee, and the Communications Catalyst for the California Chapter of American College of Cardiology.
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