White-coat hypertension detected during opportunistic blood pressure screening in a dental healthcare setting

Abstract

Objective To study white-coat hypertension (WCHT, blood pressure ≥140/90 mmHg in a clinic and normal blood pressure <135/85 mmHg at home), with blood pressure screening of a healthy population during their dental healthcare visit and the associated risk factors. Design A multicentre observational study. Setting A healthy general population at four dental clinics in a region in southern Sweden. Subjects 2025 individuals aged 40–75 years were screened for high blood pressure at their annual regular check-up dental visit. Main outcome measures Frequencies of normal and elevated blood pressure (BP) in dental clinics, with home BP as a reference. According to BP results, the population was divided into three groups: normotension (NT), WCHT and suspected hypertension (HT). Background and life style factors were measured: sex, age, family history of hypertension, body mass index (BMI kg/m2), education level, tobacco use, and physical activity level. Results The overall prevalence of WCHT in the study was 17.7%, and the prevalence was 57.2% among those with clinically high blood pressure. Compared with NT, WCHT was associated with male sex (OR 1.56, CI 1.18–2.06), older age group (OR 2.33, CI 1.66–3.26), family history of hypertension (OR 1.61, CI 1.24–2.10), high BMI kg/m2 (OR 2.36, CI 1.80–3.10), daily snuff use (OR 1.74, CI 1.19–2.53). In comparison with WCHT, HT was associated with male sex (OR 2.16, CI 1.44–3.25), older age group (OR 2.85, CI 1.75–4.65), daily smoking (OR 2.10, CI 1.14–3.85), less daily snuff use (OR 0.59, CI 0.34–0.99). Conclusions The prevalence of WCHT in a healthy population was 17.7%. Regarding cardiovascular risk factors, WCHT seems to be in the middle of NT and HT. Individuals with WCHT can be identified and given lifestyle advice in connection with a dental check-up, but follow-up and assessment of their cardiovascular risk should take place in primary care. Key points Screening in dental practice can detect white-coat hypertension (WCHT) (17.7%) and suspected hypertension (HT) (12.4%). Individuals with WCHT have more cardiovascular risk factors than normotensive individuals. Individuals with WCHT could be given lifestyle advice in dental clinics according to current guidelines.