White-coat hypertension: management and adherence to guidelines by European and Canadian GPs. A cross-sectional clinical vignette study.

Xavier Humbert,Joachim Alexandre,Paolo-Emilio Puddu,Sophie Fedrizzi,Emmanuel Touzé

doi:10.3399/bjgpopen19x101664

Abstract

BackgroundWhite-coat hypertension (WCH) is also referred to as 'isolated clinic hypertension'. While it is a frequently encountered phenomenon, WCH is not systematically evoked, and its management remains unclear due to the contradictory guidelines provided by professional societies.AimTo examine WCH management by GPs in Europe and Canada.Design & settingA clinical vignette of a possible case of WCH was created from the literature, and the responses of GPs to WCH-specific questions in a cross-sectional electronic questionnaire were compared.MethodComplete electronic questionnaire responses from Europe and Canada were systematically analysed.ResultsAmong 770 eligible questionnaires (useful response rate: 10.6%), 43.5% were from France, 19.2% from Belgium, 7.8% from England, 19.5% from Switzerland, and 10.0% from Canada. Based on the clinical information provided in the vignette, GPs overall diagnosed hypertension and WCH equally (50.7% versus 49.3%, respectively). Canadian GPs suggested hypertension more frequently than European GPs in general (64.2% versus 46.1%, P<10–4), and more frequently used ambulatory blood pressure monitoring ([ABPM] 42.3% versus 26.1%, P = 0.01). In both groups of GPs, WCH was managed similarly (no treatment, 100% versus 97.3%, P = 0.39). Generally, the GPs all followed WCH patients for 3–6 months (51.3% versus 66.2%, P = 0.1), and they were not aware of the WCH guidelines (47.3% versus 52.1%, P = 0.54).ConclusionAlthough WCH guidelines are different, WCH management by GPs is very similar except for diagnosis. Homogeneity in WCH guidelines is required and should be systematically implemented in hypertension guidelines to avoid inappropriate management of the condition.

Highlights

Blood pressure (BP) status is traditionally based on office BP measurements
Based on the clinical information provided in the vignette, GPs overall diagnosed hypertension and White-coat hypertension (WCH) (50.7% versus 49.3%, respectively)
Canadian GPs suggested hypertension more frequently than European GPs in general (64.2% versus 46.1%, P

Summary

Introduction

Blood pressure (BP) status is traditionally based on office BP measurements. When both office (GP consultation) and out-of-office BP measurements (ABPM or home BP monitoring [HBPM]) are taken into account, four patient categories can be identified: true normotension (normal office and out-ofoffice BP), essential hypertension (both elevated office and out-of-office BP), masked hypertension (normal office BP and elevated out-of-office BP), and WCH.[1,2]In 1984, Thomas Pickering wrote the original description of WCH.[3]. Blood pressure (BP) status is traditionally based on office BP measurements When both office (GP consultation) and out-of-office BP measurements (ABPM or home BP monitoring [HBPM]) are taken into account, four patient categories can be identified: true normotension (normal office and out-ofoffice BP), essential hypertension (both elevated office and out-of-office BP), masked hypertension (normal office BP and elevated out-of-office BP), and WCH.[1,2]. The results for CVD mortality were similar to those for all-cause mortality in the same study.[7]. White-coat hypertension (WCH) is referred to as 'isolated clinic hypertension'. While it is a frequently encountered phenomenon, WCH is not systematically evoked, and its management remains unclear due to the contradictory guidelines provided by professional societies

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