Study Questions Effects of White Coat Hypertension

A phenomenon that causes a spike in blood pressure at the doctor’s office may not be as dangerous as originally thought, based on recent findings that attribute the effects of white coat hypertension to age and increased heart risks.

Published in the Journal of the American College of Cardiology, this study explored the effects of white coat hypertension—a phenomenon that occurs when a patient’s blood pressure spikes at the doctor’s office but is normal at home. Studies have found that while patients with white coat hypertension have a so-called “normal” blood pressure at home, their blood pressure is slightly higher than those without this condition. Some studies have linked white coat hypertension to increased risk for heart events and poorer health outcomes, prompting questions about how to treat this unique group of patients. However, the topic remains controversial, as the effects of white coat hypertension remain unclear.

To help set the record straight, researchers conducted a large, diverse study that included more than 1,300 patients with and without white coat hypertension. Participants were from 11 different studies included in an international database, which contains data on blood pressure and key cardiovascular outcomes. All participants had multiple blood pressure readings both at the doctor’s office and at home, and were followed for outcomes like heart attack, stroke and death.

After following participants for roughly ten and a half years, researchers compared outcomes among 653 participants with white coat hypertension to 653 patients without this condition. What they found was that white coat hypertension was only associated with increased risk for heart events in older patients with “high” cardiovascular risk. High-risk participants with white coat hypertension over the age of 60 had more than two times greater risk for heart events than those with low risk. However, there was no significant difference in risk for heart events among low-risk participants with and without white coat hypertension.

High cardiovascular risk was defined as having diabetes, prior heart events or at least three other risk factors, such as high cholesterol, obesity and smoking.

What this study shows, explain authors, is that white coat hypertension may not be to blame for increased cardiovascular risk, as past studies have implied. Rather, it may be underlying health issues that increase risk in a small group of patients with white coat hypertension. As a result, we should focus on treating older, high-risk patients with white coat hypertension, who tend to have worse outcomes. With additional research, experts hope to better understand the true effects of white coat hypertension on cardiovascular risk.