1. Rosenberg, Karen


According to this study:


* People with white coat hypertension-but not white coat uncontrolled hypertension-are at increased risk for cardiovascular events and all-cause mortality compared with those who have normal blood pressure.


* Out-of-office blood pressure monitoring is important in the diagnosis and management of hypertension.



Article Content

The burden and risks for people whose blood pressure readings are elevated in the health care provider's office but normal outside the office aren't clear. The term white coat hypertension refers to patients whose blood pressure readings follow this pattern and are not receiving antihypertensive treatment, whereas white coat uncontrolled hypertension refers to those whose blood pressure follows this pattern and are receiving antihypertensive treatment. A meta-analysis evaluated the association of white coat hypertension and white coat uncontrolled hypertension with future cardiovascular events and all-cause mortality.


Studies were included in the meta-analysis if they evaluated the risks of cardiovascular events or all-cause mortality in adults who had white coat hypertension or white coat uncontrolled hypertension, had a follow-up of at least three years, and included a reference group with normotension or controlled hypertension. The 27 studies selected included 25,786 people with white coat hypertension or white coat uncontrolled hypertension and 38,487 with normotension or controlled hypertension. The mean age of the participants ranged from 43 to 72 years, and mean follow-up was three to 19 years.


Compared with people who had normotension, those with white coat hypertension had a higher risk of cardiovascular events and all-cause mortality. Studies that included stroke in their definition of cardiovascular events showed lower risk from white coat hypertension than studies that did not include stroke in the definition of cardiovascular events. White coat uncontrolled hypertension wasn't associated with an increased mortality risk. The authors note that their findings persisted across many sensitivity analyses.


Among the limitations of the study were that several subgroup analyses were limited to a very small number of studies, and few studies reported on race or ethnicity. The authors conclude that the study findings underscore the importance of guidelines recommending out-of-office blood pressure monitoring for the diagnosis of hypertension.




Cohen JB, et al. Ann Intern Med 2019 Jun 11 [Epub ahead of print].