Published: 2022-09-28

White-coat hypertension by ambulatory blood pressure monitoring in individuals with elevated office blood pressure and correlation with co-morbidities

Sasank Durugu, Srinivasa Rao


Background: White-coat hypertension characterized by elevated office blood pressure and normal ambulatory blood pressure monitor measurements has an incidence of 10-30%. It is considered that white-coat hypertension is not entirely benign condition and progression to hypertension has been identified in some cases.

Methods: 197 consecutive subjects with elevated office blood pressure measurements were evaluated by ambulatory blood pressure monitoring and assessed for co-morbidities.

Results: Of the 197 subjects evaluated 138 (70.05%) had hypertension and 59 (29.95%) had white-coat hypertension. Diabetics comprised of 21.73% of hypertensive individuals and 25.42% of white-coat hypertension individuals (p value 0.57). Similarly, when assessed for body mass index and dyslipidemia there was no statistically significant difference in both the groups.

Conclusions: White-coat hypertension is a common condition and proper assessment by ambulatory blood pressure monitoring to diagnose the condition can avoid unnecessary antihypertensive medication. Identification of other co-morbidities could lead to appropriate management goals.


White-coat hypertension, Ambulatory blood pressure monitoring, Body mass index, Diabetes mellitus, Dyslipidemia

Full Text:



Unger T. International Society for Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020;75:1334-57.

Pickering TG, James GD, Boddie C, Harshfield GA, Blank S, Laragh JH. How common is white coat hypertension? JAMA. 1988;259:225-8.

Gustavsen PH, Hoegholm A, Bang LE, Kristensen KS. White coat hypertension is a cardiovascular risk factor: a 10-year follow-up study. J Human Hypertens. 2003;17:811-7.

Sega R, Trocino G, Lanzarotti A. Alterations of cardiac structure in patients with isolated office, ambulatory or home hypertension: data from the general population. Circulation. 2001;104:1385-92.

Björklund K, Lind L, Vessby B, Andren B, Lithell H. Different metabolic predictors of white-coat and sustained hypertension over a 20-year follow-up period: a population-based study of elderly men. Circulation. 2002;106:63-8.

Khattar RS, Senior R, Lahiri A. Cardiovascular outcome in white-coat versus sustained mild hypertension. Circulation. 1998;98:1892-7.

Fagard RH, Staessen JA, Thijs L, et al. Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Response to antihypertensive therapy in older patients with sustained and nonsustained systolic hypertension. Circulation. 2000;102:1139-44.

Celis H, Staessen JA, Thijs L. Ambulatory blood pressure and treatment of hypertension trial investigators. Cardiovascular risk in white-coat and sustained hypertensive patients. Blood Press. 2002;11: 352-6.

Helvaci MR, Kaya H, Sevinc A, Camci C. Body weight and white coat hypertension. Pak J Med Sci. 2009;25(6):916-21.

Williams B, Mancia G. 2018 ESC-EHC Guidelines for the Management of Arterial Hypertension. J Hypertens. 2018;36:1953-2041.

Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison HC, et al. Guideline for the prevention, detection, evaluation, andmanagement of high blood pressure in adults: a report of the American College of cardiology/american heart association task force on clinical practice guidelines. Hypertension. 2018;71:1269-324.

Stergiou GS, Palatini P, Asmar R, Bilo G, de la Sierra A, Head G, et al. Blood pressure monitoring: theory and practice. European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability teaching course proceedings. Blood Press Monit. 2018;23:1-8.

Muntner P, Einhorn PT, Cushman WC, Whelton PK, Bello NA, Drawz PE, et al. Blood pressure assessment in adults in clinical practice and clinic-based research: JACC scientific expert panel. J Am Coll Cardiol. 2019;73:317-35.

Ohkubo T, Asayama K, Kikuya M, Metoki H, Hoshi H, Hashimoto J, et al. How many times should blood pressure be measured at home for better prediction of stroke risk? Ten-year follow-up results from the Ohasama study. J Hypertens. 2004;22:1099-104.

Verdecchia P, Schillaci G, Borgioni C. Identification of subjects with white-coat hypertension and persistently normal ambulatory blood pressure. Blood Press Monit. 1996;1:217-22

Celis H, Fagard RH. White-coat hypertension: A clinical review. Eur J Int Med. 2004; 15(6):348-57.

Ugajin T, Hozawa A, Ohkubo T. White-coat Hypertension as a Risk factor for the development of Home Hypertension. The Ohasama Study. Arch Intern Med. 2005;165:1541-6.

Hypertension in Adults: diagnosis and management. Available at: NG136. Accessed on 20 October 2021.

Salles GF, Reboldi G, Fagard RH. Prognostic effect of the nocturnal blood pressure fall in hypertensive patients. the ambulatory blood pressure collaboration in patients with hypertension (ABC-H) meta-analysis. Hypertension. 2016;67:693-700.

Hermida RC, Ayala DE, Fernandez JR, Calvo C. Chronotherapy improves blood pressure control and reverts the nondipper pattern in patients with resistant hypertension. Hypertension. 2008;51:69-76

Hermida RC, Ayala DE, Mojion A, Fernandez JR. Decreasing sleep-time blood pressure determined by ambulatory blood pressure monitoring reduces cardiovascular risk. J Am Coll Cardiol. 2011;58:1165-73.

Helvaci MR, Kaya H, duru M, Yalcin A. What is the relationship between white coat hypertension and dyslipidemia? Int Heart J. 2008;49:87-93.

Mule G, Nardi E. Metabolic syndrome in subjects with white-coat hypertension: impact on left ventricular structure and function. J Human Hypertens. 2007;21:854-60.