Blood pressures measured in the physician's office often differ considerably from those recorded during everyday activities away from the medical environment. This fact is particularly important in patients whose office blood pressures are only mildly elevated because, in a large proportion of these people, the elevation is observed only when blood pressures are measured in the physician's office and not when they are measured during normal activities. There is little evidence that this ‘white-coat’ hypertension is associated with increased cardiovascular risk, but patients with the condition are prone to develop sustained hypertension over time. It is therefore advisable to monitor these individuals regularly so that antihypertensive therapy can be initiated when appropriate.
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ManciaGParatiGPomidossiGGrassiGCasadeiRZanchettiA: Alerting reaction and rise in blood pressure during measurement by physician and nurse. Hypertension1987, 9:209–215. The authors monitored intra-arterial pressure in hospitalized patients and analysed the blood pressure responses to the arrival of a physician or a nurse at the bedside. The pressor response was highly variable from patient to patient, was more pronounced when a physician rather than a nurse took the reading and was still present when visits were repeated.
8.
WaeberBRutschmannBNussbergerJBrunnerHR: Evaluation of antihypertensive therapy: Discrepancies between office and ambulatory recorded blood pressure. J Hypertens1991, 9 (suppl 3):53–56.
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11.
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AppelLJStasonWB: Ambulatory blood pressure monitoring and blood pressure self-measurement in the diagnosis and management of hypertension. Ann Intern Med1993, 118:867–882.
O'BrienEPetrieJLittlerWde SwietMPadfieldPLO'MalleyK: The British Hypertension Society protocol for the evaluation of automated and semi-automated blood pressure measuring devices with special reference to ambulatory systems. J Hypertens1990, 8:607–619. This paper describes the protocol proposed by the British Hypertension Society for the evaulation of non-invasive ambulatory blood pressure recorders. It gives the different steps of the validation procedures and the system for grading the devices. This protocol in now frequently used to test new apparatus.
16.
O'BrienEAtkinsNMeeFO'MalleyK: Comparative accuracy of six ambulatory devices according to blood pressure levels. J Hypertens1993, 11:673–675.
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Di RienzoMGrassiGPedottiAManciaG: Continuous versus intermittent blood pressure measurements in estimating 24 hour average blood pressure. Hypertension1983, 5:264–269.
18.
Jacot des CombesBPorchetMWaeberBBrunnerHR: Ambulatory blood pressure recordings: Reproducibility and unpredictability. Hypertension1984, 3:C110–C115. This study compared blood pressures obtained by a physician in standardized conditions with daytime ambulatory pressures. Major differences were found between the two sets of data, and it was impossible to predict ambulatory blood pressures from office pressures.
19.
CoatsAJS: Reproducibility or variability of casual and ambulatory blood pressure data: Implications for clinical trials. J Hypertens1990, 8 (suppl 6):17–20. This study showed that the reproducibility over 1 month of ambulatory blood pressures is better than that of office pressures. The main reason for this is the greater number of readings made available by ambulatory monitoring, which improves the precision of the estimate of usual blood pressure.
20.
ClarkLADenbyLPregibonD: The effects of activity and time of the day on the diurnal variations of blood pressure. J Chronic Dis1987, 40:671–681.
21.
FlorasJSJonesJVHassanMOOsikowskaBSeverPSSleightP: Cuff and ambulatory pressure in subjects with essential hypertension. Lancet1981, 2:107–109. Intra-arterial, clinic and ambulatory pressures were recorded in 59 patients with borderline or essential hypertension. The authors found that large discrepancies existed between cuff and ambulatory pressures and that ambulatory blood pressure could not be predicted on the basis of office pressure.
22.
ShimadaKOguraHKawamotoAMatsubayashiKIshidaHOzawaT: Non-invasive ambulatory blood pressure monitoring during clinic visit in elderly hypertensive patients. Clin Exp Hypertens1990, A12:151–170. This study elegantly illustrates the blood pressure changes that occur when patients are sitting in the physician's waiting room, when they are in the examining room and when they leave the physician's room. The data confirmed that blood pressures inside the physician's room are often substantially higher than those determined outside. In addition, the magnitude of the rise in blood pressure caused by the physician was unpredictable.
23.
WaeberBJacot des CombesBPorchetMBiollazJSchallerMDBrunnerHR: Ambulatory blood pressure recording to identify hypertensive patients who truly need therapy. J Chronic Dis1984, 37:55–57.
24.
SpenceJDBassMRobinsonHCCheungHMelendezLJArnoldJMO: Prospective study of ambulatory monitoring and echocardiography in borderline hypertension. Clin Invest Med1991, 14:241–250.
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VerdecchiaPSchillaciGBoldriniFZampiIPorcellatiC: Variability between current definitions of ‘normal’ ambulatory blood pressure. Implications in the assessment of white coat hypertension. Hypertension1992, 20:555–562.
26.
ChristenYGanslmayerMWaeberBBurnierMNussbergerJBrunnerH: Use of non-invasive ambulatory blood pressure monitoring to screen for high-risk hypertensive patients. J Hypertens1990, 8 (suppl 6):119–124. The authors compared office and ambulatory pressures in 475 consecutive untreated patients diagnosed as hypertensive. The data confirmed that the difference between the two types of blood pressure measurement is unpredictable in a given patient. They show, however, that patients with slightly elevated blood pressures in the physician's office are more likely to have ‘normal’ (mean of all values 140/90mmHg) ambulatory blood pressures during the day.
27.
O'BrienEAtkinsNO'MalleyK: Defining normal ambulatory blood pressure. Am J Hypertens1993, 6 (suppl 2):201S–206S.
28.
StaessenJFagardRLijnenPThijsLvan HoofRAmeryA: Reference values for ambulatory blood pressure: A metaanalysis. J Hypertens1990, 8 (suppl 6):57–64. The authors performed a meta-analysis of published studies in order to propose reference levels for normal ambulatory pressure. The data are useful because they involve observations made in a large number of subjects.
29.
DevereuxRBPickeringTG: Relationship between ambulatory or exercise blood pressure and left ventricular structure: Prognostic implications. J Hypertens1990, 8 (suppl 6):125–134.
30.
WhiteWBSchulmanPMcCabeEJDeyHM: Average daily blood pressure but not office blood pressure determines cardiac function in patients with hypertension. JAMA1989, 261:873–877. This study is important because it shows that patients with high blood pressures during ambulatory monitoring as well as in the physician's office are more prone to develop cardiac hypertrophy than are patients whose blood pressures are high only in the presence of a physician.
31.
GossePPromaxHDurandetPClementyJ: White coat hypertension. No harm for the heartHypertension1993, 22:766–770.
32.
CardilloCDe FeliceFCampiaUFolliG: Psychophysiological reactivity and cardiac end-organ changes in white coat hypertension. Hypertension1993, 21:836–844.
33.
WaeberBBorgesTChristelerPGuillaume-GentilMHollensteinUMannhartM: Amlodipine compared to nitrendipine in hypertensive patients: The effects on toleration in relationship to the onset of action. Cardiology1992, 80 (suppl 1):46–53.
34.
BurnierMBiollazJMagninJLBidlingmeyerMBrunnerHR.Renal sodium handling in patients with untreated hypertension and white coat hypertension. Hypertension1993, 23:496–502. This study aimed to investigate renal sodium handling in patients with established hypertension, in those with white-ccat hypertension and in normotensive individuals. Evidence was found for enhanced proximal re-absorption of sodium (by measuring lithium clearance) in patients with high blood pressures in the physician's office, irrespective of their ambulatory blood pressure status. This suggests that white-coat hypertension represents a transitional prehypertensive state.
35.
BidlingmeyerMBurnierMBidlingmeyerIWaeberBBrunnerHR: Long-term evolution of blood pressure in patients with white coat hypertension [abstract]. J Hypertens1994, 12 (suppl 3):7.
