Published in:
Journal of Hypertension, 42 (2024) Suppl 1, Seite e193-e194
Language:
English
DOI:
10.1097/01.hjh.0001021384.66164.d8
ISSN:
1473-5598;
0263-6352
Origination:
Footnote:
Description:
Objective: White Coat Hypertension (WCH) is defined as elevated office blood pressure (BP) readings with a normal blood pressure during ambulatory blood pressure monitoring (ABPM). We recently established a dedicated “fast track” clinic for diagnosis of hypertension among soldiers. We assumed that WCH might be highly prevalent among these examinees, whose blood pressure is measured in a stressful, non-standardized, military setting. Since home BP for diagnosing of WCH is not feasible among most military personnel, we aimed at comparing possible alternatives: standardized hospital clinic BP, aortic (central) BP measurement or 24-hour ABPM. Design and method: We estabished a dedicated hypertension clinic, in which soldiers who are off duty for a long weekend (Thursday-Sunday) undergo full hypertension workup during 2 consecutive work days. The workup consists of standardized clinic BP, measured by an experienced medical technician, central BP measurement and 24-hour ABPM as well as echocardiography, renal ultrasound, renal artery doppler, fundoscopic exam, blood and urine tests. Results: During 2023, 56 examinees were seen in our clinic. Thirty-five of those (68.6% men, median age 20) were referred due to repeated elevated BP in a military setting (BP>=140/90mmHg), but no clear diagnosis of hypertension. Sixteen of these patients (45.7%) were diagnosed as WCH by 24-hour ABPM. Standardized office BP measurements done by a medical technician unmasked the white coat effect (WCE) in 5 patients (31.2% of WCH). Central (aortic) BP measurements followed the standardized BP measurements and were within normal limits in patients with normal standardized brachial BP measurements. Similarly, central BP was elevated in those with elevated standardized brachial BP measurements. Conclusions: WCH is more common among women, elderly and obese and occurs in up to 30% of subjects with elevated blood pressure. We found a prevalence of 45.7% among young examinees, most of whom were men. Standardized clinic BP measurements unmasked 31.2% of WCH cases, possibly, as they were performed by a technician and not a physician. However, 24 hour ABPM is mandatory in order to diagnose WCH. Central BP measurement adds no value as compared to brachial BP.