If White Coat Causes Spike, Heart Risk Climbs
Written by Editor   
Friday, July 03, 2015 01:05 PM
Quick Brief:  It seems that "white coat syndrome" when it comes to hypertension is still an indicator of increased risk of cardiovascular events.


Hypertension seen in the office but not on home monitoring or vice versa might still carry some cardiovascular risk according to two separate studies supporting 24-hour monitoring.  In one study, after adjustment for other factors, white coat hypertension was associated with a 2.01-fold higher risk of cardiovascular events than those with completely normal blood pressure.

In a second study of people with normal blood pressure by 24-hour ambulatory monitoring, those whose pressure failed to drop at least 10% at night had a 44% elevated adjusted risk of cardiovascular events compared with normal dipping.  "That means that dipping adds prognostic information to blood pressure level and therefore the basic conclusion is that cardiovascular risk needs to be redefined in terms of the actual level of blood pressure during sleep and potential appearance of a nondipping blood pressure value."

The problem is that, while the U.S. Preventive Services Task Force appears set to recommend 24-ambulatory monitoring for diagnosis following an in-office measurement in the hypertensive range, the more intensive monitoring isn't recommended or typically done for people not shown to have office elevations.

But once more studies replicate the link to event-free survival, "it is not a matter of decision, either you measure blood pressure during sleep or you have no clue about who is going to have risk or not risk of myocardial infarction or stroke.  It is not just worth it, it is going to be a requirement sooner or later."

Source:  http://www.medpagetoday.com/MeetingCoverage/ASH/51647