White-coat Hypertension

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Presentation transcript:

White-coat Hypertension Presenter: Wang Siheng 10301010032

Historical Description In 1896, Riva-Rocci first described the “white-coat effect”. In 1940, Ayman first discovered the clinical relevance of white-coat effect. In 1983, Mancia et al. first made the direct quantification of white-coat hypertension.

Current Definition Mean arterial pressure Heart rate Office visits: ≥140 mmHg systolic ≥90 mmHg diastolic or both Out-of-office within the normal range Two possibilities: Blood pressure increased during clinical visits. Blood pressure decreased when in home.

Features About 30-40% patients are normal at home. Weak relationship with race & sex. Increased risk in elderly. Large interindividual variability. Relationship with artherosclerosis.

Pathogenesis “Defense activation” Diencephalic area Cardiovascular adjustments & Emotional behavior Laboratory stressors caused hypertension & white-coat hypertension. Endothelial abnormalities & hyperadrenergic state was observed. Sympathetic nerve traffic

Clinical importance Cross-sectional studies: The pathologic change in organs of white-coat hypertension patients did not have prognostic significance. Longitudinal studies: No difference of statistic significance was observed between cohorts in short-term studies. White-coat hypertension might not be clinically benign. Ambulatory blood pressure monitoring is recommended. Data based on ambulatory blood pressure monitoring Data based on traditional methods

Vocabulary White-coat hypertension Systolic pressure Diastolic pressure Sympathetic nerve traffic prognostic significance Ambulatory blood pressure monitoring

Reference Mancia, G., et al., Diagnosis and management of patients with white-coat and masked hypertension. Nature Reviews Cardiology, 2011. 8(12): p. 686-693. Ernst, M.E., Ambulatory Blood Pressure Monitoring: Recent Evidence and Clinical Pharmacy Applications. Pharmacotherapy, 2013. 33(1): p. 69-83. Mancia, G., et al., Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Hypertension, 2006. 47(5): p. 846-853. Grassi, G., et al., Muscle and skin sympathetic nerve traffic during the "White-Coat" effect. Circulation, 1999. 100(3): p. 222-225. Goldman, L. and A.I. Schafer, Goldman’s Cecil medicine. 24th ed. 2012, Philadelphia: Elsevier Inc.