Abstract
The medical visit, or more in general the situation of being in a clinical environment, often leads the patient to experience an alerting reaction and a transient increase in blood pressure (BP) levels [1–3], known as the “white coat effect” [4]. This represents a major problem associated with BP measurement in clinical practice, as it prevents BP measures obtained in the clinic from accurately reflecting the “true” subject’s blood pressure values. Although the first description of this phenomenon was performed by the end of the nineteenth century [5], it was thanks to the observations made by studies implementing sophisticated systems for continuous BP monitoring in ambulatory conditions that the nature and mechanisms responsible for the pressor response to the medical visit could be better understood [1, 3]. These pioneering studies not only provided direct and precise quantitative assessment of the BP rise associated with the doctor’s visit but also indicated that it is the alerting reaction and not the cuff inflation at the moment of BP measurement that causes this pressor response [1, 6].
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Mancia G, Bertinieri G, Grassi G, Parati G, Pomidossi G, Ferrari A, Gregorini L, Zanchetti A (1983) Effects of blood-pressure measurement by the doctor on patient’s blood pressure and heart rate. Lancet 2(8352):695–698
Mancia G, Ferrari A, Gregorini L, Parati G, Pomidossi G, Bertinieri G, Grassi G, di Rienzo M, Pedotti A, Zanchetti A (1983) Blood pressure and heart rate variabilities in normotensive and hypertensive human beings. Circ Res 53(1):96–104
Mancia G, Parati G, Pomidossi G, Grassi G, Casadei R, Zanchetti A (1987) Alerting reaction and rise in blood pressure during measurement by physician and nurse. Hypertension 9(2):209–215
Pickering TG, James GD, Boddie C, Harshfield GA, Blank S, Laragh JH (1988) How common is white coat hypertension? JAMA 259(2):225–228
Riva Rocci S (1897) The technique of sphygmomanometry. Gazz Med Torino 10:981–1017
Parati G, Pomidossi G, Casadei R, Mancia G (1985) Lack of alerting reactions to intermittent cuff inflations during noninvasive blood pressure monitoring. Hypertension 7(4):597–601
Little P, Barnett J, Barnsley L, Marjoram J, Fitzgerald-Barron A, Mant D (2002) Comparison of agreement between different measures of blood pressure in primary care and daytime ambulatory blood pressure. BMJ 325(7358):254
Julius S, Mejia A, Jones K, Krause L, Schork N, van de Ven C, Johnson E, Petrin J, Sekkarie MA, Kjeldsen SE et al (1990) “White coat” versus “sustained” borderline hypertension in Tecumseh, Michigan. Hypertension 16(6):617–623
O’Brien E, Parati G, Stergiou G, Asmar R, Beilin L, Bilo G, Clement D, de la Sierra A, de Leeuw P, Dolan E et al (2013) European society of hypertension position paper on ambulatory blood pressure monitoring. J Hypertens 31(9):1731–1768
Parati G, Ulian L, Santucciu C, Omboni S, Mancia G (1998) Difference between clinic and daytime blood pressure is not a measure of the white coat effect. Hypertension 31(5):1185–1189
Parati G, Casadei R, Groppelli A, Di Rienzo M, Mancia G (1989) Comparison of finger and intra-arterial blood pressure monitoring at rest and during laboratory testing. Hypertension 13(6 Pt 1):647–655
Lantelme P, Milon H, Vernet M, Gayet C (2000) Difference between office and ambulatory blood pressure or real white coat effect: does it matter in terms of prognosis? J Hypertens 18(4):383–389
Palatini P, Palomba D, Bertolo O, Minghetti R, Longo D, Sarlo M, Pessina AC (2003) The white-coat effect is unrelated to the difference between clinic and daytime blood pressure and is associated with greater reactivity to public speaking. J Hypertens 21(3):545–553
Parati G, Omboni S, Mancia G (1996) Difference between office and ambulatory blood pressure and response to antihypertensive treatment. J Hypertens 14(6):791–797
Leary AC, Donnan PT, MacDonald TM, Murphy MB (2002) The white-coat effect is associated with increased blood pressure reactivity to physical activity. Blood Press Monit 7(4):209–213
Siegel WC, Blumenthal JA, Divine GW (1990) Physiological, psychological, and behavioral factors and white coat hypertension. Hypertension 16(2):140–146
Shimada K, Ogura H, Kawamoto A, Matsubayashi K, Ishida H, Ozawa T (1990) Noninvasive ambulatory blood pressure monitoring during clinic visit in elderly hypertensive patients. Clin Exp Hypertens A Theory Pract 12(2):151–170
Mancia G, Sega R, Bravi C, De Vito G, Valagussa F, Cesana G, Zanchetti A (1995) Ambulatory blood pressure normality: results from the PAMELA study. J Hypertens 13(12 Pt 1):1377–1390
Mancia G, Omboni S, Parati G, Ravogli A, Sega R, Ulian L (1994) Ambulatory blood pressure monitoring in the diagnosis of hypertension and evaluation of antihypertensive drug efficacy. Blood Press Suppl 2:20–22
Thijs L, Amery A, Clement D, Cox J, de Cort P, Fagard R, Fowler G, Guo C, Mancia G, Marin R et al (1992) Ambulatory blood pressure monitoring in elderly patients with isolated systolic hypertension. J Hypertens 10(7):693–699
Owens P, Atkins N, O’Brien E (1999) Diagnosis of white coat hypertension by ambulatory blood pressure monitoring. Hypertension 34(2):267–272
Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Zampi I, Gattobigio R, Sacchi N, Porcellati C (1995) White coat hypertension and white coat effect. Similarities and differences. Am J Hypertens 8(8):790–798
Hoegholm A, Kristensen KS, Madsen NH, Svendsen TL (1992) White coat hypertension diagnosed by 24-h ambulatory monitoring. Examination of 159 newly diagnosed hypertensive patients. Am J Hypertens 5(2):64–70
Myers MG, Valdivieso M, Kiss A (2009) Use of automated office blood pressure measurement to reduce the white coat response. J Hypertens 27(2):280–286
1999 World Health Organization-International Society of hypertension guidelines for the management of hypertension. Guidelines subcommittee (1999). J Hypertens 17(2):151–183
Hypertension control. Report of a WHO Expert Committee (1996). World Health Organ Tech Rep Ser 862:1–83
Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A et al (2013) 2013 ESH/ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 31(7):1281–1357
Pickering T (1996) Recommendations for the use of home (self) and ambulatory blood pressure monitoring. American Society of Hypertension Ad Hoc Panel. Am J Hypertens 9(1):1–11
Ben-Dov IZ, Ben-Arie L, Mekler J, Bursztyn M (2007) Reproducibility of white-coat and masked hypertension in ambulatory BP monitoring. Int J Cardiol 117(3):355–359
Spence JD, Bass M, Robinson HC, Cheung H, Melendez LJ, Arnold JM, Manuck SB (1991) Prospective study of ambulatory monitoring and echocardiography in borderline hypertension. Clin Invest Med 14(3):241–250
Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, Jones DW, Kurtz T, Sheps SG, Roccella EJ (2005) Recommendations for blood pressure measurement in humans and experimental animals: Part 1: blood pressure measurement in humans: a statement for professionals from the subcommittee of professional and public education of the American Heart Association Council on High Blood Pressure Research. Hypertension 45(1):142–161
Dolan E, Stanton A, Atkins N, Den Hond E, Thijs L, McCormack P, Staessen J, O’Brien E (2004) Determinants of white-coat hypertension. Blood Press Monit 9(6):307–309
Verdecchia P, Schillaci G, Boldrini F, Zampi I, Porcellati C (1992) Variability between current definitions of ‘normal’ ambulatory blood pressure. Implications in the assessment of white coat hypertension. Hypertension 20(4):555–562
Staessen JA, Bieniaszewski L, O’Brien ET, Imai Y, Fagard R (1996) An epidemiological approach to ambulatory blood pressure monitoring: the Belgian population study. Blood Press Monit 1(1):13–26
Imai Y, Nagai K, Sakuma M, Sakuma H, Nakatsuka H, Satoh H, Minami N, Munakata M, Hashimoto J, Yamagishi T et al (1993) Ambulatory blood pressure of adults in Ohasama, Japan. Hypertension 22(6):900–912
Staessen JA, Fagard RH, Lijnen PJ, Thijs L, Van Hoof R, Amery AK (1991) Mean and range of the ambulatory pressure in normotensive subjects from a meta-analysis of 23 studies. Am J Cardiol 67(8):723–727
Fagard RH, Cornelissen VA (2007) Incidence of cardiovascular events in white-coat, masked and sustained hypertension versus true normotension: a meta-analysis. J Hypertens 25(11):2193–2198
Mancia G, Facchetti R, Bombelli M, Grassi G, Sega R (2006) Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Hypertension 47(5):846–853
Verdecchia P, Palatini P, Schillaci G, Mormino P, Porcellati C, Pessina AC (2001) Independent predictors of isolated clinic (‘white-coat’) hypertension. J Hypertens 19(6):1015–1020
Sega R, Cesana G, Milesi C, Grassi G, Zanchetti A, Mancia G (1997) Ambulatory and home blood pressure normality in the elderly: data from the PAMELA population. Hypertension 30(1 Pt 1):1–6
Martinez MA, Garcia-Puig J, Martin JC, Guallar-Castillon P, Aguirre de Carcer A, Torre A, Armada E, Nevado A, Madero RS (1999) Frequency and determinants of white coat hypertension in mild to moderate hypertension: a primary care-based study. Monitorizacion Ambulatoria de la Presion Arterial (MAPA)-area 5 working group. Am J Hypertens 12(3):251–259
Hoegholm A, Kristensen KS, Bang LE, Nielsen JW (1998) White coat hypertension and target organ involvement: the impact of different cut-off levels on albuminuria and left ventricular mass and geometry. J Hum Hypertens 12(7):433–439
Staessen JA, O’Brien ET, Amery AK, Atkins N, Baumgart P, De Cort P, Degaute JP, Dolenc P, De Gaudemaris R, Enstrom I et al (1994) Ambulatory blood pressure in normotensive and hypertensive subjects: results from an international database. J Hypertens Suppl Off J Int Soc Hypertens 12(7):S1–S12
Cushman WC, Ford CE, Cutler JA, Margolis KL, Davis BR, Grimm RH, Black HR, Hamilton BP, Holland J, Nwachuku C et al (2002) Success and predictors of blood pressure control in diverse North American settings: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). J Clin Hypertens (Greenwich) 4(6):393–404
Hajjar I, Kotchen TA (2003) Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA 290(2):199–206
de la Sierra A, Segura J, Banegas JR, Gorostidi M, de la Cruz JJ, Armario P, Oliveras A, Ruilope LM (2011) Clinical features of 8295 patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoring. Hypertension 57(5):898–902
Persell SD (2011) Prevalence of resistant hypertension in the United States, 2003-2008. Hypertension 57(6):1076–1080
Ahmed MI, Calhoun DA (2011) Resistant hypertension: bad and getting worse. Hypertension 57(6):1045–1046
Elliott WJ (2011) High prevalence of white-coat hypertension in Spanish resistant hypertensive patients. Hypertension 57(5):889–890
de la Sierra A, Banegas JR, Oliveras A, Gorostidi M, Segura J, de la Cruz JJ, Armario P, Ruilope LM (2012) Clinical differences between resistant hypertensives and patients treated and controlled with three or less drugs. J Hypertens 30(6):1211–1216
Oikawa T, Obara T, Ohkubo T, Kikuya M, Asayama K, Metoki H, Komai R, Murai K, Hashimoto J, Totsune K et al (2006) Characteristics of resistant hypertension determined by self-measured blood pressure at home and office blood pressure measurements: the J-HOME study. J Hypertens 24(9):1737–1743
Parati G, Stergiou GS, Asmar R, Bilo G, de Leeuw P, Imai Y, Kario K, Lurbe E, Manolis A, Mengden T et al (2008) European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on home blood pressure monitoring. J Hypertens 26(8):1505–1526
Parati G, Bilo G, Mancia G (2003) White coat effect and white coat hypertension: what do they mean? Cardiovasc Rev Rep 24:477–484
Mancia G, Zanchetti A (1986) Handbook of Hypertension. Vol. 7. Elsevier B.V., pp. 125–152
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Parati, G., Ochoa, J.E., Lombardi, C., Bilo, G. (2015). White Coat Hypertension: Definition, Terminology and Prevalence. In: White Coat Hypertension. Springer, Cham. https://doi.org/10.1007/978-3-319-07410-8_1
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