The diagnosis of arterial hypertension has made it increasingly complex over time. It is no longer just to tell a patient “you suffer from arterial hypertension”. Nowadays, there are more abnormal blood pressure categories added to the list as prehypertension, “white-coat” hypertension and “masked” hypertension. No doubts, the complexity of the human been plays its role in all this (1)
Many patients have been said over years that they had “emotional hypertension” since her or his blood pressure (BP) at the medical office was elevated even after several BP readings at prudent intervals during the consultation, whereas at home blood pressure remained normal.
The abovementioned situation was overlooked by the medical community for a long time and there was a long-standing thinking that it was simply the result of patient’s stress arising from the patient-doctor encounter at the clinic. However, as time went by, the so-called white-coat effect was study in-depth and as a result, the “white-coat” hypertension term emerged (2)
Is it dangerous? Yes indeed, several investigations have shown that:
A “white-coat” hypertension can lead to overt arterial hypertension and the likelihood of an overall increase in the global cardiovascular risk for the patient. Therefore, recognition and awareness are key.
Is it the patient’s anxiety due to the patient-doctor encounter at the clinic?
According to recent studies, this is not the most important thing but this:
Anticipation not only of actually taking the blood pressure but the interpretation of the result by the doctor and its imagined significance on the health status seems to be the main stimulus of the white coat effect. Anticipation ranks more highly than anxiety.
The mechanism is considered to be a conditioned reflex that, once established persisted for visit after doctor’s visit, year upon year. It does not change with time or with prolonged association with the physician (3)
In short, recognition of this condition reduces patient’s worry, relieves them both of a lifetime of unnecessary medication and the side effects of the otherwise ever-increasing dosages and diminishes the frustration of the attending physician.
In my opinion, to break this vicious psychological cycle since its recognition is paramount. Now we know that the disruption of this reflex might prevent worse things from happening in the future.
I believe that the first step to be taken is make the patient aware of this which would “cushion” the anticipation-related fear.
Once again, the treatment of hypertension cannot rely only on drugs but in taking the time to talk to the patient during a consultation time.
However the non-unusual rush by some physician at the office due to the timed consultations when others patients are awaiting outside may hamper a desired outcome.
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1- Wang XX, Shuai W, Peng Q, Li JX, Li P, Cheng XS, Su H. White coat effect in hypertensive patients: the role of hospital environment or physician presence. J Am Soc Hypertens. 2017 Aug;11(8):498-502.
2- Huang Y, Huang W, Hu Y. Is White-Coat Hypertension Associated With Risk of Cardiovascular Diseases?. J Am Coll Cardiol. 2017 Jun 13;69(23):2880. doi: 10.1016/j.jacc.2017.02.073.
3- Bloomfield DA, Park A. Decoding white coat hypertension. World J Clin Cases. 2017 Mar 16;5(3):82-92.