White coat hypertension in a general practice - prevalence, cardiovascularrisk factors and clinical implications

Objective - To examine the prevalence of white coat hypertension (WCH) and white coat effect (WCE) in a general practice. Background and biochemical c haracteristics, triglycerides, total cholesterol, HDL cholesterol, fasting blood glucose, microalbuminuria, EGG, smoking habits, height and weight of patients with white coat hypertension were compared to patients with sustai ned hypertension. Design - Blood pressure measurements among mild hypertensives in clinic vis its by doctor and at home by the patients. Setting - A primary health centre in Oslo, Norway. Subjects - Sixty-eight patients with mild hypertension (41 females and 27 m ales) aged 20-75 years. Main outcome measures - Patients had their blood pressure measured in clini c visits by general practitioners and by themselves at home to study the pr evalence of WCH and the WCE. WCH was defined as a consistently increased bl ood pressure in the clinic and a normal home-measured blood pressure. WCE w as defined as a difference in mean systolic blood pressure measured by phys ician and patients of 10 mmhg, or more. An individual risk score for myocar dial infarction was calculated. Subjects with and without WCH/ WCE were com pared in relation to background characteristics and biochemical differences . Results - Fourteen patients (21%) were found with WCH, while 25 (37%) had W CE. Patients with WCH differed significantly from hypertensives in age, tot al cholesterol, and heart rate. In multivariate analysis, increasing age an d heart rate were significant negative predictors for WHC. Conclusion - WCH may be a significant clinical challenge in general practic e, especially among younger patients.