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White coat hypertension: not so benign after all?

Journal of Human Hypertension volume 17, pages 807–809 (2003)Cite this article

White coat hypertension (WCH) describes the phenomenon in which blood pressures are elevated in the presence of a health professional measuring the blood pressure—traditionally described (but not exclusively!) in relation to the hospital/clinic doctor, who is usually wearing a white coat. Since the introduction of 24 h ambulatory blood pressure monitoring (ABPM),1 the meaning of WCH has been redefined, and one possible definition of WCH is an abnormal clinic blood pressure but ‘normal’ ABPM. The latter has also been defined in many ways, but the recent Seventh Joint National Committee (JNC 7)2 suggested that the upper limits of ‘normal’ ABPM to be 135/85 mmHg while patients are awake and 120/75 mmHg while they are asleep. In contrast, the 1999 World Health Organization/International Society of Hypertension (WHO/ISH) guidelines3 suggest that a 24 h average of home blood pressure of 120/80 mmHg as corresponding to clinic blood pressure of 140/90 mmHg.

WCH was probably first described by Riva-Rocci more than 100 years ago. The prevalence of WCH is quite variable, depending of the selection of the patient groups. For example, in 1988, Pickering et al4 first reported the prevalence of WCH to be 21% of all hypertensives, and they were more likely to be female. Other studies have suggested a prevalence of between 12 and 54%,5 being more common in the elderly.6 WCH may also account for up to 25% of cases labelled as ‘resistant hypertension’.7 Clearly, WCH is a common phenomenon.

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  1. University Department of Medicine, City Hospital, Birmingham, B18 7QH, England, UK

    Irene Chung & Gregory YH Lip

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  1. Irene Chung
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Correspondence to Gregory YH Lip.

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Chung, I., Lip, G. White coat hypertension: not so benign after all?. J Hum Hypertens 17, 807–809 (2003). https://doi.org/10.1038/sj.jhh.1001651

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