Blood pressure that rises only in the doctor's office -- so-called
"white-coat" hypertension -- may be more serious than
Researchers report that patients with white-coat hypertension showed
signs of heart damage similar to, but not as severe as, patients
with chronic high blood pressure.
Currently, experts remain divided on whether white-coat hypertension,
which is thought to be due to the stress of a healthcare visit,
is a benign condition or a sign of heart disease that should be
The researchers found that the walls of the left ventricle, one
of the heart's upper chambers, appeared thicker in patients with
white-coat hypertension, compared with those with normal blood pressure
levels. They were also more likely to show left ventricular hypertrophy,
an enlargement of the chamber linked to the risk of heart attack
As expected, those with chronic high blood pressure showed the
highest degree of damage to the left ventricle.
Although the study does not explain the underlying mechanism of
the left-ventricle changes seen in patients with white-coat hypertension,
the authors note that temporary blood pressure increases, caused
by exaggerated response to mild stress may have an effect on cardiac
growth, leading to hypertrophy.
The results of this study support the hypothesis that white-coat
hypertension should not be simply considered a benign condition.
At present, with our knowledge of the benefits of lowering blood
pressure and the realization that this usually does not involve
complicated or dangerous regimens, it is good policy to treat white-coat
Blood pressure readings are taken in two numbers. The systolic
value (the first number in a blood pressure measurement) describes
the pressure in the heart during contraction. The second number,
the diastolic value, represents the pressure when the heart is at
rest between beats.
Blood pressure readings above 140/90 mm Hg are considered high.
In this study, white-coat hypertension was defined as having a systolic
pressure over 140 or a diastolic pressure over 90 during doctor
visits, but a regular daytime blood pressure of 130/80 or less.
Archives of Internal Medicine