Prevalence and determinants of white coat effect in a large UK hypertension clinic population

Abstract

White coat hypertension (WCH) is common and termed white coat effect (WCE) in those on treatment for hypertension. The UK guideline suggests that all patients in stage 1 and 2 hypertension, but not stage 3 hypertension, should have ambulatory blood pressure monitoring (ABPM) performed before commencing treatment. The relationship between office blood pressure (BP) and ABPM and the factors that influence the WCE were examined in a large British cohort (n=2056) from 2 hypertension clinics (1998-2011). Data were collected prospectively: the median age was 56 years: 53% were female, 76% Caucasian, 9% African Caribbean, 15% South Asian and 86% taking antihypertensives. Fifty-one percent had WCE and differences between clinic BP and ABPM measurements increased with the stage of hypertension varying from 2/4 (normotensive), 13/10 (stage 1 hypertension), 24/14 (stage 2) and 40/20 mm Hg (stage 3). The degree of difference is greater in this study than described in other populations. A positive correlation was found between clinic systolic and diastolic BP and the WCE (r=0.74 and r=0.56, respectively, P<0.0001). Significant (P<0.05) independent associations of systolic WCE were clinic systolic BP (β=0.707), Caucasian ethnicity (South Asian β=-0.06; African Caribbean β=-0.043), female gender (male β=-0.047), nonsmoking status (smoker β=-0.100) and reduced renal function (estimated glomerular filtration rate β=-0.036). Significant independent associations of diastolic WCH were clinic diastolic BP (β=0.624), age (β=0.207), female gender (male β=-0.104), Caucasian ethnicity (South Asian β=-0.052, African Caribbean β=-0.079) and being a nonsmoker (β=-0.082) or ex-smoker (β=0.046). The results support current UK guidelines but suggest those with stage 3 hypertension would also benefit from ABPM.