Is white-coat hypertension innocent?
1996; Elsevier BV; Volume: 348; Issue: 9028 Linguagem: Inglês
10.1016/s0140-6736(05)65069-6
ISSN1474-547X
Autores Tópico(s)Cardiovascular Health and Disease Prevention
ResumoEven in the 18th century the presence of the doctor was known to affect the pulse of the patient. In 1940 when Ayman and Goldshine 1 Ayman D Goldshine AD Blood pressure determinations by patients with essential hypertension. I. The difference between clinic and home readings before treatment. Am J Med Sci. 1940; 200: 465-474 Crossref Google Scholar reported higher clinic than home values for 38 patients followed up for 2 years, they attributed the higher clinic readings to “the excitement and tension associated with the visit to the clinic or doctor's office”. A consistent finding of many recent studies has been that 15–30% of individuals with mild hypertension on repeated clinic or office recordings exhibit normal home blood-pressure profiles. 2 Verdecchia P Porcellati C Schillaci G et al. Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension. Hypertension. 1994; 24: 793-801 Crossref PubMed Scopus (1647) Google Scholar , 3 Staessen JA O'Brien ET Atkins N Emery AK Ad-Hoc Working Group Ambulatory pressure in normotensive compared with hypertensive subjects. J Hypertens. 1993; 11: 1289-1297 PubMed Google Scholar The aetiology is obscure. These individuals do not exhibit abnormal cardiovascular responses to pressure stimuli; nor do they have personality profiles that are distinguishing. White-coat hypertension as a cause of cardiovascular dysfunctionFunctional cardiovascular abnormalities were identified in white-coat hypertensive patients who had no identifiable structural abnormalities. Such functional abnormalities can be reversed by antihypertensive treatment. We propose that patients with white-coat hypertension might benefit from antihypertensive treatment as well as those with persistent hypertension. This hypothesis should be addressed in prospective clinical trials. Full-Text PDF
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