Diagnosis Of White-coat Hypertension Research Articles

P075 IS OFFICE BLOOD PRESSURE MEASUREMENT SUFFICIENT FOR DIAGNOSING HYPERTENSION IN PRIMARY HEALTH CARE?

Background and Objective: Recent guidelines have recommended out-of-office blood pressure (BP) measurement to improve the accuracy of the diagnosis of hypertension (HTN) but there are few studies evaluating its use in the scope of primary care. Our objective is to assess the degree of agreement between office BP and HBPM, evaluating their use in a young population assisted in primary care. Methods: This is a cross-sectional population study with adults between 20-50 years old registered in the Family Health Strategy. Sociodemographic, anthropometric data and CV risk factors were recorded. Office BP was the mean of 2 measurements and HBPM followed the 7-day protocol. HBPM < 135 x 85 mmHg and office BP < 140 x 90 mmHg were considered normal, identifying the 4 phenotypes: Normotension (controlled office BP and HBPM); white-coat HTN (uncontrolled office BP and controlled HBPM); masked HTN (controlled office BP and uncontrolled HBPM) and sustained HTN (uncontrolled office BP and HBPM). Results: 475 individuals were included (male sex: 38%; mean age: 37.6 years ± 8.8 years, of which 93 (20%) had their diagnosis modified after HBPM (43 with white-coat and 47 with masked HTN). In multiple logistics regression, male gender (OR 3.87: 95%CI 1.70-8.82) was independently correlated with white-coat HTN, while obesity and prehypertension increased the risk of masked HTN by 2 and 5.5 times, respectively. Uncontrolled office BP has high specificity (89%) and low sensitivity (49%) for detecting sustained HTN, with a low concordance in the diagnosis of HTN (kappa=0.388) Among men with uncontrolled office BP, 55.6% had a diagnosis of white-coat HTN and among women, 37.1%. Conclusion: Office BP was not a sufficient measurement to diagnose hypertension. HBPM was a useful procedure in this young and apparently healthy population in primary care, especially in those with uncontrolled office BP to identify white-coat HTN and in those with high normal office BP, especially if they are male or obese for early diagnosis of masked HTN.

Self-Measure Office Blood Pressure (SMOBP) and Home Blood Pressure Monitoring (HBPM) for white coat effect diagnosis among hypertension patients

Background: Hypertension is a critical factor in the deaths over the world among those who have cardiovascular diseases such as coronary artery disease, stroke, and chronic kidney disease.Purpose: This study aims to investigate the diagnosis capability of the white coat effect in hypertensive patients whose blood pressure was not on target.Methods: This study is an analytical study. Data were collected from 19 uncontrolled hypertension patients at Bang Si Thong health promoting hospital from August to December 2022. The geographic data are presented in the descriptive statistic terms of mean, difference, and standard deviation. The research outcome was analyzed by paired t-test.Results: The research results showed blood pressure measurement by SMOBP was more valuable in terms of statistical significance than Daytime HBPM (134±8.21 vs 125.5±6.74 p<0.001), while it was statistically significantly lower than Office-measured (148.15±10.33 vs 134±8.21 p<0.001), and there were participants whose blood pressures were going as a targeted by SMOBP 55% and HBPM 80%.Conclusion: Self-Measure Office Blood Pressure [SMOBP] can eliminate some of the white coat effect, but it could not be used instead of Home Blood Pressure Monitoring [HBPM] for the diagnosis of white coat hypertension. The SMOBP might be a choice for patients who have the white coat effect in socioeconomically disadvantaged areas.

Abstract 15741: Is Home Blood Pressure Monitoring Useful in Diagnosing Hypertension in Young Adults in Primary Care?

Introduction: Recent guidelines have recommended out-of-office blood pressure (BP) measurement to improve the accuracy of the diagnosis of hypertension (HTN) but there are few studies evaluating its use in the younger population and in the scope of primary care. Objective: To assess the degree of agreement between office BP and Home Blood Pressure Monitoring (HBPM), evaluating their use in a young population assisted in primary care. Methods: This is a cross-sectional population study with adults between 20-50 years old registered in the Family Health Strategy. Sociodemographic, anthropometric data and cardiovascular risk factors were recorded. Office BP was the mean of 2 measurements and HBPM followed the 7-day protocol. HBPM < 135 x 85 mmHg and office BP < 140 x 90 mmHg were considered normal while dentifying the 4 phenotypes: Normotension (controlled office BP and HBPM); white-coat HTN (uncontrolled office BP and controlled HBPM); masked HTN (controlled office BP and uncontrolled HBPM) and sustained HTN (uncontrolled office BP and HBPM). Results: 475 individuals were included (male sex: 38%; mean age: 37.6 years ± 8.8 years) of which 93 (20%) had their diagnosis modified after HBPM (43 with white-coat and 47 with masked HTN). Through multiple logistics regression, male gender (OR 3.87: 95%CI 1.70-8.82) was independently correlated with white-coat HTN, while obesity and prehypertension increased the risk of masked HTN by 2 and 5.5 times respectively. Uncontrolled office BP had high specificity (89%) and low sensitivity (49%) for detecting sustained HTN, with a low concordance in the diagnosis of HTN (kappa=0.388). Among men with uncontrolled office BP, 55.6% had a diagnosis of white-coat HTN and among women, 37.1%. Conclusion: HBPM was a useful tool in the diagnosis of hypertension in a young and apparently healthy population in primary care, especially in those with uncontrolled office BP to identify white-coat HTN, and in those with high normal office BP, especially if they were male or obese, for early diagnosis of masked HTN.

The Role of Ambulatory Blood Pressure Monitoring in Current Clinical Practice.

Hypertension continues to be the leading modifiable risk factor for stroke, kidney disease and cardiovascular disease, and it also plays a key role in a significant proportion of preventable deaths globally. Ambulatory blood pressure monitoring (ABPM) is an underutilised tool that augments the accurate diagnosis of hypertension. Out-of-office blood pressure measurements such as ABPM, permits the diagnosis of white coat hypertension and masked hypertension as well as determining a patient's nocturnal dipping status. These common clinical phenotypes have relevance with regard to clinical outcomes and may impact management. Overall, the diagnosis and management of hypertension presents numerous challenges, requiring the complementary use of multimodal blood pressure monitoring. Familiarity with the use of ABPM is important in the optimal management of patients, particularly as it becomes more accessible with the recent introduction of a Medicare Benefits Schedule item number.

HOME BLOOD PRESSURE MONITORING: REPORT OF A DATABASE OF 1474 PATIENTS

Objective: Hypertension is a highly prevalent disease, considered one of the main risk factors for major cardiovascular events. Out of office blood pressure (BP) evaluation has been encouraged in the most recent hypertension guidelines, once validated devices become more available with reasonable costs and good quality. White coat hypertension phenomenon is defined as a clinical condition when the patient has elevated office BP values and normal values at home readings through home blood pressure monitoring(HBPM) or 24 hour BP monitoring. The aim of this study is to review a databank of 1,474 patients who performed HBPM assisted at a private cardiology clinic, highlighting the cases of white coat hypertension. Design and method: We evaluated the HBPM results of 1474 patients from a private cardiology clinic, in Recife/PE, Brazil. The device model used on all patients was the Omron 705 CP BP Monitor during 5 days after explanation of the correct usage and protocol (3 readings in the morning and 3 at night, before meals), excluding the first day of the readings. Results: 1474 patients were studied, 57.8% woman, with average age of 53.4 years (+− 16.17). The average office measurement of systolic BP was 130.68 mmHg (+−18.54) and diastolic of 81.83 mmHg (+− 11.55). The mean systolic pressure of the HBPM tests was 123.99 mmHg (+−14.3) and the diastolic was 76.5 mmHg (+−8.99). 196 patients (13.3% of the group) had the diagnosis of white coat hypertension. 50.5% were male and the average age was 56 years old (+− 15.15). The mean office systolic BP was 148.5 mmHg (+−11.79) and diastolic was 90 mmHg (+−8.78). The overall average of the HBPM for the systolic BP was 125 mmHg (+−6.78) and diastolic of 76.4 mmHg (+−6.44). Conclusions: White coat hypertension had significant high prevalence among evaluated patients, highlighting the importance of the HBPM for arterial hypertension diagnosis. Therefore, it is important to follow the most recent guidelines from all over the world, as the latest European one, which suggests the importance of HBPM in order to avoid the misdiagnosis of hypertension and unnecessary medication.

Preeclampsia for the Nephrologist: Current Understanding in Diagnosis, Management, and Long-term Outcomes.

Preeclampsia is a multisystem progressive disorder of pregnancy that can be potentially catastrophic for the mother and the fetus. It involves complex perturbations of the kidney and systemic physiology, along with long-term effects on vascular and kidney health. Thus, the nephrologist plays a key role in the peripartum and long-term management of preeclampsia. Recent translational research has improved our understanding of its pathophysiology, and there is hope for novel therapies. In this review, we discuss the evolution of diagnostic criteria and dilemmas in the diagnosis of hypertensive disorders in pregnancy. We summarize the advances in the pathogenesis and prediction of preeclampsia. We describe the management and prevention of preeclampsia focusing specially on the forthcoming strategies from the nephrologist's perspective. We address the evidence regarding long-term outcomes for the mother and the child. We end with exploring areas warranting future research.

Diagnosis of Pediatric Hypertension: European Society of Hypertension-Recommended 24-Hour vs. 24-Hour-Day-Night Ambulatory Blood Pressure Thresholds.

The impact of diagnosing pediatric hypertension based on all three-24-hour, day and night ambulatory blood pressure (ABP) thresholds (combined ABP threshold) vs. conventionally used 24-hour ABP threshold is not known. In this cross-sectional, retrospective study from a tertiary care outpatient clinic, we evaluated the diagnosis of hypertension based on the 24-hour European Society of Hypertension (ESH) and combined ESH ABP thresholds in untreated children with essential hypertension. The American Academy of Pediatrics (AAP) and Fourth Report thresholds were used to classify office blood pressure (OBP). In 159 children, aged 5-18 years, the 24-hour ESH and combined ESH thresholds classified 82% (95th confidence interval (CI) 0.68, 0.97) ABP similarly with the area under the curve (AUC) of 0.86 (95th CI 0.80, 0.91). However, the AUC of the 2 ABP thresholds was significantly higher in the participants with office hypertension than office normotension, with OBP classified by the AAP (AUC 0.93, 95th CI 0.84, 0.98 vs. 0.80, 95th CI 0.71, 0.88) or Fourth Report (AUC 0.93, 95th CI 0.83, 0.98 vs. 0.81, 95th CI 0.73, 0.88) threshold. With OBP classified by the either OBP threshold, the combined ESH threshold diagnosed significantly more masked hypertension (MH) (difference 15%, 95th CI 4.9, 24.7; P = 0.00); however, the diagnosis of white coat hypertension (WCH) by the 2 ABP thresholds did not differ significantly (difference 4%, 95th CI 1.8, 10; P = 0.16). In children with essential hypertension, the 24-hour and combined ESH thresholds have a stronger agreement for diagnosing WCH than MH.

DIAGNOSTIC ACCURACY OF OFFICE BLOOD PRESSURE FOR THE DIAGNOSIS OF WHITE COAT AND MASKED HYPERTENSION

Objective:The aim of this study was to identify the best cut off values of office blood pressure (BP) for the diagnosis of white coat hypertension (WCHT) and masked hypertension (MHT).Design and method:542 consecutive subjects (50.2% male, age 42.5 ± 26.2 years) were included in the study. Subjects

Ambulatory Blood Pressure Monitoring: Profiles in Chronic Kidney Disease Patients and Utility in Management.

Optimal control of blood pressure (BP) may reduce the risk of progression of CKD. Misclassification of hypertension (HTN) and status of control may result in suboptimal management. Clinic or home BP may overestimate or underestimate status of control compared with ambulatory BP monitoring (ABPM), which is considered the gold standard. The latter relates not only to the superiority of ABPM concerning outcome prognosis but also to its ability to accurately diagnose white coat and masked HTN, which is critical in assuring adequate BP control. However, ABPM has not gained widespread use in practice because of limited third-party reimbursement and a paucity of high quality randomized controlled intervention studies evaluating its use. Herein, we review HTN phenotypes that have been identified in patients with CKD, and the potential value of ABPM in this high-risk population.

Diagnosis of White Coat Hypertension and pregnancy outcomes.

Diagnosis of White Coat Hypertension and pregnancy outcomes.

Importance of ambulatory blood pressure monitoring in the diagnosis and prognosis of pediatric hypertension

The prevalence of high blood pressure (BP) at pediatric age has increased progressively, one of the causes of which is obesity. However, the dominant etiology in this age group is renal and/or cardiovascular pathology. Ambulatory blood pressure monitoring (ABPM) is the method of choice for the diagnosis of hypertension, especially in children at high cardiovascular risk. Its use is limited to children from five years of age. Choosing appropriate cuff size is key to obtaining correct blood pressure. The main indication for ABPM is to confirm the diagnosis of hypertension. It also allows the diagnosis of white coat hypertension (which may represent an intermediate stage between the normotensive phase and hypertension), or masked hypertension, associated with progression to sustained hypertension and left ventricular hypertrophy (LVH). Children with isolated nocturnal hypertension should be considered as having masked hypertension. BP load is defined as the percentage of valid measurements above the 95th percentile for age, gender, and height. Values above 25-30% are pathological and those above 50% are predictive of LVH. ABPM correlates with target organ damage, particularly LVH and renal damage. It is useful in the differentiation of secondary hypertension, since these children show higher BP load and less nocturnal dipping, and confirmation of response to therapy. Thus ABPM allows the diagnosis and classification of hypertension, provides cardiovascular prognostic information and identifies patients with intermediate phenotypes of hypertension.

The differential diagnostic value of serum homocysteine for white coat hypertension.

ObjectiveTo assess the value of serum homocysteine (Hcy) in differential diagnosis of white coat hypertension (WCH).ResultsIn this retrospective study, serum Hcy levels were elevated in hypertensive patients (P < 0.001) compared to WCH patients. Serum Hcy levels were positively correlated with 24-h mean systolic blood pressure, r = 0.1378, P < 0.001. The results of the receiving operating characteristic (ROC) curve showed that the AUC value of Hcy was 0.80 (95% CI, 0.77–0.83), the cut-off value was 13.8 μmol/L, the sensitivity was 68.58% and the specificity 87.21%. In the prospective study, the AUC value of Hcy was 0.73 (95% CI: 0.67–0.78), higher than N - terminal pro - brain natriuretic peptide(NT-pro-BNP) (0.64, 95% CI:0.58–0.70) and cystatin C (Cys-C) (0.62, 95% CI:0.55–0.68). Hcy, NT-proBNP and Cys-C combined, provided a better indication of a differential diagnosis of WCH, than Hcy alone.Materials and MethodsThis investigation involved both a retrospective and a prospective study. Clinical data including blood pressure, age, sex, height, weight, BMI, smoking status, past history, and behavioral electrocardiogram of patients who had undergone 24-hour ambulatory blood pressure monitoring (ABPM) with elevated clinical blood pressure (BP) were recorded. Pearson correlation analysis was used to test the correlation between Hcy and BP. The ROC curve was used to analyze the value of measuring Hcy levels in differential diagnosis of WCH.ConclusionsSerum Hcy was decreased in WCH patients and therefore could be a biomarker for differential diagnosis of WCH.

My Life With Fibromuscular Dysplasia: A Sword of Damocles.

My story begins in December 2007 when I visited my general practitioner (GP) for one of the first times since the birth of my third son in 1992. At the time, I worked as a GP myself and had been at the same busy Scottish practice since qualifying in 1986. I also led an active life outside of work, ran a youth group at church and enjoyed regular gym workouts and several sports. Being a mother of 3 boys kept me constantly on the go! I had never suffered any major illness, was on no medication, and had no obvious risk factors for heart or vascular disease. Having suffered 3 months of morning headaches and some elevated blood pressure readings (around 170/100) taken at my office, I felt I should seek medical advice. I was also experiencing extra heart beats (ventricular ectopics) fairly frequently and some mild left-sided upper back discomfort. Some basic blood tests were done, along with another blood pressure reading, and I was referred to a cardiologist. The cardiologist performed an EKG, which showed normal patterns other than frequent ventricular ectopics. My blood pressure readings were mildly elevated at 158/100 and later 142/95. No heart murmurs were found, and an echocardiogram was normal. An appointment was arranged for me to have ambulatory blood pressure recordings to see how my blood pressure behaved over a 24-hour period, and an initial diagnosis of white coat hypertension was made. This is defined as blood pressure that is raised when measured by medical professionals but normal outside the doctor’s office. My ambulatory blood pressure recordings were within normal limits, and no further action was taken. My morning headaches and occasional palpitations continued, but I was able to manage the headaches with simple analgesics. In September 2009, at age 49, I suffered …

Abstract P216: Association Between White-coat Hypertension and Arterial Stiffness: a Systematic Review and Meta-analysis

Background: Previous studies have shown inconclusive effects of target organ damage from white-coat hypertension (WCHT). Arterial stiffness is involved in the atherosclerotic processes in the setting of sustained hypertension. This meta-analysis aimed to compare arterial stiffness in subjects with diagnosis of WCHT to subjects with normotension (NT) and SHT. Methods: A comprehensive search of the databases of the MEDLINE and EMBASE was performed from inception through May 2016. The inclusion criterion was the observational studies’ assessment of the association between WCHT and NT or SHT in adult subjects. European Society of Hypertension practice guidelines for ambulatory blood pressure (BP) monitoring was used to define WCHT (office BP≥140/90mmHg and daytime BP &lt;135/85mmHg), and SHT (office BP≥140/90mmHg and daytime BP≥135/85mmHg). Aortic stiffness was assessed using Carotid-femoral pulse wave velocity (PWV) measurements. Pooled mean difference (MD) of PWV and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. Results: Data were extracted from 4 observational studies involving 2,413 subjects. PWV is not different in patients with WCHT compared with SHT (pooled MD= -0.25 m/sec; 95% CI, -0.81 to 0.30; P-value=0.37, I 2 =74%). PWV in WCHT is also not different when compared with PWV in NT (MD= 0.86 m/sec; 95% CI, -0.30 to 2.03; P-value=0.15, I 2 =97%). Conclusion: In a meta-analysis, we observe that arterial stiffness measured by pulse wave velocity is not different in patients with white-coat hypertension when compared with sustained hypertension or normotension.

21 White coat hypertension in pregnancy: High incidence rates of gestational hypertension and preeclampsia

Aim (1) To investigate what fraction of hypertension (HT) is white coat hypertension (WCH) in pregnant women without a past history of HT, (2) to compare the incidence rates of preeclampsia (PE) among normal pregnant women showing normal blood pressure (controls), WCH, and chronic hypertension (CH), and (3) to compare the incidence rates of gestational hypertension (GH) between controls and WCH. Methods This is a retrospective cohort study in 2934 pregnant women, who sought maternal checkup at Results (1) In 2934 women, 41 women had a past history of WCH ( n =3), and CH ( n =38). In the remaining 2893 women, 2837 women (98.1%) were normal blood pressure, 36 women (1.2%) were WCH, and 20 women (0.7%) were CH, thus, the prevalence of WCH in newly diagnosed HT in pregnancy was 64% (36/56). (2) The incidence rates of PE in controls, WCH, and CH were 1.7% (48/2,837), 15% (6/39), and 21% (12/58), respectively; the incidence rates of PE in WCH and CH were significantly higher than in controls ( p p p =0.600). (3) The incidence rate of GH in WCH was significantly higher than in controls (23% (9/39) vs. 1.3% (37/2,837), p Conclusions Almost two-third of the newly diagnosed HT in pregnancy was WCH. Therefore, the precise diagnosis of WCH is essential to avoid unnecessary anti-hypertensive therapy. The incidence rate of hypertensive disorders of pregnancy (PE plus GH) in women with WCH was 38%. Therefore, we should recognize WCH as very high risk for GH or PE, and should monitor women with WCH by HBP very carefully.

Стрес-індукована артеріальна гіпертензія та артеріальна гіпертензія військового часу — грізні виклики сучасній Україні

У статті наведені дані щодо проблеми стресу, його ролі в життєдіяльності людини, у підвищенні артеріального тиску. Розглянуті основні патофізіологічні механізми стрес-індукованої артеріальної гіпертензії (АГ), способи її діагностики, можливість формування прогностично несприятливих уражень органів-мішеней. Показана важливість проведення добового моніторування артеріального тиску для діагностики «АГ білого халата», маскованої АГ, у тому числі АГ на робочому місці. Наведені дані щодо артеріальної гіпертензії військового часу як одного з варіантів стрес-індукованої артеріальної гіпертензії, її особливості та труднощі у дослідженні її патогенезу. Запропоновані схеми лікування стрес-індукованої артеріальної гіпертензії та її ускладнень.

Home Blood Pressure Monitoring.

Hypertension is the most common preventable cause of cardiovascular disease. Home blood pressure monitoring (HBPM) is a self-monitoring tool that can be incorporated into the care for patients with hypertension and is recommended by major guidelines. A growing body of evidence supports the benefits of patient HBPM compared with office-based monitoring: these include improved control of BP, diagnosis of white-coat hypertension and prediction of cardiovascular risk. Furthermore, HBPM is cheaper and easier to perform than 24-hour ambulatory BP monitoring (ABPM). All HBPM devices require validation, however, as inaccurate readings have been found in a high proportion of monitors. New technology features a longer inflatable area within the cuff that wraps all the way round the arm, increasing the 'acceptable range' of placement and thus reducing the impact of cuff placement on reading accuracy, thereby overcoming the limitations of current devices.

Abstract 409: Reproducibility of White Coat and Masked Hypertension Definitions One Year after the Diagnosis

A significant number of subjects present discordant results when BP is measured both at the clinic and by 24-hour ABPM. The aim of the study was to assess the reproducibility of a diagnosis of normotension (NT), white coat hypertension (WCH), masked hypertension (MH) and sustained hypertension (SH) in a cohort of untreated subjects who underwent a second ABPM without being treated with antihypertensive drugs. From the Spanish ABPM Registry, we selected 843 untreated subjects who underwent at least 2 BP examinations (both at the clinic and by ABPM) separated by 2 months or more (median,IQR: 13; 6-28 months), and who did not receive antihypertensive drug treatment in the period lasting between the 2 examinations. The 4 above mentioned categories were defined by normal (&lt;140/90 mmHg) or elevated BP at the clinic (mean of 2 measurements), and by normal (&lt;130/80 mmHg) or elevated 24-hour BP. At baseline, 140 (17%), 206 (25%), 78 (9%), and 414 (49%) had NT, WCH, MH, and SH, respectively. At the 2nd clinic and ABPM examination 52% of NT, 55% of WCH, 47% of MH, and 82% of SH fall into the same category. In both the WCH and MH categories, the most frequent switch was to SH (26% and 33%, respectively). When patients who changed or remained in the same category were compared, there were no differences in clinical variables, such as age, gender, or prevalence of obesity, diabetes, or previous cardiovascular disease. Both clinic and ambulatory BP were higher in patients who fall into the same category in both examinations, but this was driven by the higher reproducibility of SH. In the specific group of WCH (206 patients) there were no significant BP differences at baseline between the 114 who maintained such diagnosis, compared to the 54 patients who developed SH. Conversely, in the 78 patients with MH at baseline, those who developed SH at the 2nd examination (26) had higher levels of clinic diastolic BP (84±4 vs. 80±5 mmHg; p=0.006), compared with those who remained with MH (37). In conclusion, the diagnosis of SH is highly reproducible after one year of the first diagnosis. However, a diagnosis of WCH or MH requires a close follow-up, as almost 50% of patients do not show the same diagnosis and develop SH. There is no a specific clinical pattern which can be of help to predict which patients will develop SH.

White-Coat Hypertension

> Two statisticians meet . > > -How do you do? > > -How do I do? Compared to whom? > > — Anonymous Thomas Pickering coined the term white-coat hypertension to denote individuals who were not on treatment for hypertension but who had elevated office blood pressure and normal daytime blood pressure measured with ambulatory blood pressure monitoring (ABPM). Clearly, these individuals would be at low cardiovascular risk.1 The traditional definition of white-coat hypertension is based, therefore, on an elevated office blood pressure with a normal blood pressure during the awake period with ABPM. However, because of the contribution of asleep blood pressure as a predictor of outcome, it seems counterproductive to exclude this period from consideration. The most recent European guidelines2 propose, therefore, an alternative definition of white-coat hypertension, which encompasses subjects with office systolic/diastolic blood pressure readings of ≥140/90 mm Hg and a 24-hour blood pressure <130/80 mm Hg. The purpose of this review is to provide new insights into the characteristics, definitions, and cardiovascular risk assessment in persons with white-coat hypertension, and it will be limited primarily to ABPM with a primary focus on prospective studies. ### Prevalence and Diagnosis White-coat hypertension occurs in 15% to 30% of subjects with an elevated office blood pressure,2,3 and the phenomenon is reasonably reproducible.2,4 Although there are no pathognomonic diagnostic features of white-coat hypertension, this condition occurs more frequently in women, older adults, nonsmokers, recently diagnosed patients with hypertension with a limited number of conventional blood pressure measurements in the office setting who have mild hypertension, pregnant women, and subjects without evidence of target organ damage.2,5,6 The misdiagnosis of subjects with white-coat hypertension as being truly hypertensive can result in them being penalized for employment and insurance rating, as well as being prescribed unnecessary lifelong treatment with potential side …

Clinical significance of home blood pressure and its possible practical application

Home blood pressure (BP) is highly reproducible and its reproducibility is better than ambulatory BP. Because of this feature, home BP has a greater prognostic value at least than clinic BP and is extremely effective for the evaluation of drug effects and their duration. The introduction of home BP for the diagnosis and treatment of hypertension facilitates long-term BP control. Home BP is particularly important for the diagnosis and treatment of hypertension in renal diseases, diabetes mellitus, pregnancy, and children. Home BP measurements improve adherence to medications and medical consultations, and are indispensable for diagnosis of white coat hypertension and masked hypertension. Such efficiency improves the medical economy. Home BP can detect minimal change in BP mediated by medication, and intrinsic and extrinsic stimuli and detect long-term change in BP. Thus, home BP is now indispensable for improvement in the management of hypertension in medical practice as well as for the recognition of hypertension in the general population. Standardization of the measurement procedure may elevate the position of home BP in the practice of diagnosing and treating hypertension.