1. White-coat Hypertension
Presenter: Wang Siheng

2. 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.

3. 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.

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

5. 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

6. 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

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

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