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Prevalence and determinants of white coat effect in a large UK hypertension clinic population

Journal of Human Hypertension volume 30, pages 386–391 (2016)Cite this article

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Abstract

White coat hypertension (WCH) is common and termed white coat effect (WCE) in those on treatment for hypertension. The UK guideline suggests that all patients in stage 1 and 2 hypertension, but not stage 3 hypertension, should have ambulatory blood pressure monitoring (ABPM) performed before commencing treatment. The relationship between office blood pressure (BP) and ABPM and the factors that influence the WCE were examined in a large British cohort (n=2056) from 2 hypertension clinics (1998–2011). Data were collected prospectively: the median age was 56 years: 53% were female, 76% Caucasian, 9% African Caribbean, 15% South Asian and 86% taking antihypertensives. Fifty-one percent had WCE and differences between clinic BP and ABPM measurements increased with the stage of hypertension varying from 2/4 (normotensive), 13/10 (stage 1 hypertension), 24/14 (stage 2) and 40/20 mm Hg (stage 3). The degree of difference is greater in this study than described in other populations. A positive correlation was found between clinic systolic and diastolic BP and the WCE (r=0.74 and r=0.56, respectively, P<0.0001). Significant (P<0.05) independent associations of systolic WCE were clinic systolic BP (β=0.707), Caucasian ethnicity (South Asian β=−0.06; African Caribbean β=−0.043), female gender (male β=−0.047), nonsmoking status (smoker β=−0.100) and reduced renal function (estimated glomerular filtration rate β=−0.036). Significant independent associations of diastolic WCH were clinic diastolic BP (β=0.624), age (β=0.207), female gender (male β=−0.104), Caucasian ethnicity (South Asian β=−0.052, African Caribbean β=−0.079) and being a nonsmoker (β=−0.082) or ex-smoker (β=0.046). The results support current UK guidelines but suggest those with stage 3 hypertension would also benefit from ABPM.

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Acknowledgements

We thank Mr Roger Holder, Head of Statistics (retired), School Health and Population Science, University of Birmingham, for his help and advice with statistical analysis; Dr Peter Nightingale, Statistician, University Hospital of Birmingham, for statistical advice on the manuscript; and Mr Lee Hollingworth, IT manager, Renal Department of Birmingham Heartlands Hospital, for his help with the hypertension database.

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  1. Renal Unit, Heart of England NHS Foundation Trust, Birmingham, UK

    O Thomas, K E Shipman, K Day, M Thomas & I Dasgupta

  2. Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK

    U Martin

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Thomas, O., Shipman, K., Day, K. et al. Prevalence and determinants of white coat effect in a large UK hypertension clinic population. J Hum Hypertens 30, 386–391 (2016). https://doi.org/10.1038/jhh.2015.95

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