Doctors do not know what causes white coat hypertension, which may have different triggers in different patients. For some people, anxiety can cause blood pressure to rise in a medical setting, but others may have fluctuating blood pressure due to an underlying physiological condition.
Patients with untreated white coat hypertension had a 36% increase in heart disease risk, a 33% increase in the risk of death from any cause, and a 109% increase in the risk of death from heart disease, according to the analysis.
This finding was "more robust" in studies where participants were on average 55 years or older and studies that included patients with previous cardiovascular disease, according to Dr. Jordana Cohen, co-author of the study and assistant professor of medicine and epidemiology. at the University of Pennsylvania Perelman School of Medicine.
A separate group of patients with variable blood pressure readings were not at high risk – those who experienced the "effect" of the white lab coat. They are patients whose blood pressure is only high in their offices, but normal at home, and they are already taking blood pressure medication. They did not present an increased risk of cardiovascular events or mortality, the analysis showed.
Although more research is needed, "we encourage lifestyle modifications (including improved diet, exercise, weight loss, alcohol use reduction, and smoking cessation) in all patients with white-coat hypertension," the researchers concluded.
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The new research suggests the opposite, Shimbo said, although he noted that the finding "does not apply to everyone."
"If you were older – you were at least 55 years old – had a history of cardiovascular disease or had chronic kidney disease or diabetes, white-coat hypertension would be associated with an increased risk of cardiovascular events and mortality." he said.
In addition, the high risk in patients with white coat hypertension is "not strong, not weak, somewhere in between," said Shimbo, who questioned the risks for people not included in the analysis: those with sustained hypertension in and outside the doctor's office).
The risk of cardiovascular events and death among patients with white coat hypertension is somewhere in the middle of the spectrum and is "substantially lower" than that of patients with consistent high blood pressure readings, he said.
Despite finding a high risk for cardiovascular events, including heart attacks and coronary artery disease, the meta-analysis found no relationship between white coat hypertension and stroke. "This unexpected finding may benefit from further investigation," noted Shimbo and Muntner.
Most guidelines say that outpatient monitoring – in which a patient uses a sophisticated device that automatically inflates and deflates, measuring blood pressure even during sleep – is the preferred approach, but is not available for everyone, he explained.
Home monitoring – in which a patient self-measures blood pressure, usually with a non-fully automatic shop-bought device – is more practical and helpful, Shimbo said, adding that patients need a "decent device that is need". "and to ensure that they follow the instructions.