The answer to the Image Quiz from 12/27/11 is white coat hypertension (WCH).
White coat hypertension (WCH) is a phenomenon in which patients exhibit elevated blood
pressure in a clinical setting but not in other settings. 20-30% of apparently resistant
hypertension is WCH. Patients with WCH have an
increased risk of CV events and often have some degree of end organ damage. One
needs to use home or ambulatory monitoring to sort out the problem.
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White coat hypertension (WCH) is a phenomenon in which patients exhibit elevated blood
pressure in a clinical setting but not in other settings. 20-30% of apparently resistant
hypertension is WCH. Patients with WCH have an
increased risk of CV events and often have some degree of end organ damage. One
needs to use home or ambulatory monitoring to sort out the problem.
In a meta-analysis by Bangash and Agarwal published in CJASN, of 980 patients with CKD identified in six studies, the overall
prevalence of white-coat hypertension was 18.3%.
One of the recommendations from “A Joint Scientific
Statement From the American Heart Association, American Society of Hypertension,
and Preventive Cardiovascular Nurses Association”
published in Hypertension in 2008 is to perform home blood pressure monitoring.
They state: “HBPM is indicated in patients with newly diagnosed or suspected
hypertension, in whom it may distinguish between white-coat and sustained
hypertension. If the results are equivocal, ambulatory BP monitoring may help
to establish the diagnosis.”
