White Coat Effect Causes Excessive Antihypertensive Treatment in Low Risk Patients

Office recording blood pressure (BP) gives at best a rough estimate of a person’s usual BP, and it is controversial that a few office BP determinations govern the diagnosis and treatment guidelines for hypertension. In this context it acquires importance the white coat effect (WCE), which is a significant fall in ambulatory BP compared with that measured in a clinical setting.Despite the introduction of ambulatory pressure, specially 24h BP monitoring (ABPM) has had a great impact on both the decision to treat or not a patient (P) with hypertension, it has not been considered either in fundamental studies such as the Sprint or in the diagnostic and treatment recent guidelines for hypertension.In our country, primary care physicians have taken new objectives of BP treatment very seriously based only on their office records.Hypertensive P with visión déficits, from the neuroophthalmology section of our hospital, are periodically referred to our Laboratory for screening of hypertension and vascular complications. In the last two years 62 P were evaluated.In low risk (LR) P, who do not have hypertensive target organ damage or chronic symptoms, we observed a temporal relationship between ocular symptoms and the start or increase of antihypertensive treatment So we decide to carry out a preliminary prospective study including LR hypertensive P between Sep 2017 to Mar 2019. P older than 80 and those who had secondary hypertension were excluded. All were studied with ABPM to compare ambulatory and office BP values, day and night time BP.BP was recorded when they were derived and in a subsequent visit a week later where the ambulatory monitor pressure was also placed.The results showed in LR group significantly higher office systolic (S) BP values (143±11 mm Hg) compared with ambulatory BP: 24h SBP 117±8 mm Hg (p<0.01), daytime SBP 120±9 mm Hg (p<0.01) and nigthtime SBP 94±8 mm Hg (p<0.01), and we observed WCE in 18 of 30 P (56%). Under estimating or not detecting WCE can lead to excessive antihypertensive treatment and cause ocular and other tissues hypoflux. Conclusions: In low risk P office BP values should be corroborated with ambulatory BP values, either systematic ambulatory monitoring or with 24 h ABPM before starting or before increasing the antihypertensive treatment.