WHITE-COAT HYPERTENSION IN PATIENTS WITH NEWLY-DIAGNOSED HYPERTENSION- EVALUATION OF PREVALENCE BY AMBULATORY MONITORING AND IMPACT ON COST OF HEALTH-CARE

To evaluate the prevalence of 'white-coat' hypertension in patients wi th newly diagnosed hypertension, 255 subjects (131 males and 124 femal es) underwent 24-h ambulatory blood pressure monitoring. Patients with 24-h systolic and diastolic blood pressure <135/85 mmHg were classifi ed as white-coat hypertensives and the remaining as sustained hyperten sives. On the assumption that white-coat hypertensives may not need to take antihypertensive medication, we evaluated the impact on cost of health care of two strategics based essentially on treating all patien ts according to casual blood pressure, or ambulatory blood pressure mo nitoring, followed by drug treatment in sustained hypertensives only. Of the 255 hypertensives studied 54 (21%), confidence interval 16%, 26 %, were classified as white-coat hypertensives. The age, sex-ratio and body mass index did not differ between the white-coat and the sustain ed hypertensive subjects. The strategy of monitoring all patients and of treating only the sustained hypertensives resulted in a substantial cost saving, which was calculated to be about 110 000 U.S.A. dollars over a period of 6 years. In conclusion, white-coat hypertensives are frequent among patients with newly diagnosed hypertension, and they do not differ from sustained hypertensives as regards demographic data. Ambulatory blood pressure monitoring, when used to decide whether or n or to treat pharmacologically, increases the cost-effectiveness of tre atment for hypertension and reduces the cost of health care.