Pulse Pressure May Be Clue to White Coat Hypertension

Measurement of pulse pressure may help identify patients with “white coat” hypertension, according to data presented by Korean researchers at the American College of Cardiology’s 60th Annual Scientific Session in New Orleans.

A total of 1087 outpatients from university hospital settings who had chronic hypertension were enrolled in the study. Participants were taught how to properly measure their blood pressure and then checked and recorded it at home every morning and evening for 2 weeks. Researchers defined the white coat effect as a positive difference between a blood pressure reading in the physician’s office and the home measurement.

White coat hypertension was identified in 31% of patients. In the analysis, pulse pressure was positively correlated with systolic white coat effect (P < .001) and diastolic white coat effect (P < .001). The presence of white coat effect was defined as a difference above 20 mm Hg in systole or 10 mm Hg in diastole. The averages of white coat effect were 9.8 ± 14.8 mm Hg in systole and 3.4 ± 9.2 mm Hg in diastole.

"Even though 24-hour ambulatory blood pressure monitoring or self-monitoring is useful for the diagnosis of white coat effect whenever clinical suspicion is raised, pulse pressure seems to be a simple parameter for suspicion of white coat effect in people without aortic valvular insufficiency or aortic disease," said Youngkeun Ahn, MD, of Chonnam National University Hospital, Gwangju, South Korea, and lead investigator of the study on behalf of Korean Hypertension Research Network. "If we detect it more easily, we can avoid some over-treatment of these patients."

Ahn Y et al. Can Pulse Pressure Predict White Coat Effect in Treated Hypertensive Patients? Presented at ACC 2011. April 4, 2011. New Orleans, La.

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