Symptoms
White coat hypertension refers to the measurement of high blood pressure in the presence of a health care professional, nurses, and generally in medical settings. The pulse may also be accelerated. The values are elevated in contrast to self-measurement at home or outpatient measurement. White coat hypertension is a common phenomenon and is observed in up to 15% of patients. Rarely, the opposite is also observed. Conversely, in so-called “masked hypertension,” elevated blood pressure is measured only outside the office.
Causes
The cause of hypertension is emotional excitement, stress or anxiety caused by the presence of a health professional or the situation in the office. It is also called practice hypertension and isolated clinical hypertension. This raises the problem that an otherwise healthy person may be misdiagnosed and treated as hypertensive. Risk factors include:
- Mild hypertension (stage I).
- Female gender
- Age
- Non-smoker
The excitement does not even necessarily have to be perceived subjectively by the person. White coat hypertension can also occur in people with hypertension. It may precede hypertension and, according to the literature, may itself be a risk for cardiovascular disease, which is why it should be monitored regularly.
Diagnosis
If the diagnosis of hypertension raises the suspicion that blood pressure is artificially elevated because of the white-coat effect, home self-measurement or 24-hour measurement should be considered. Normal values can also be measured by nursing staff under certain circumstances. When self-monitoring, good patient instruction is important (see under Blood Pressure Measurement).
Treatment
If high values are also observed during self-measurement or end-organ damage and metabolic disturbances are present, hypertension is treated with nonmedication and medication. If, on the other hand, white coat hypertension alone is present, the patient should have regular blood pressure checks and be monitored by a physician.
