White coat hypertension: current state of the issue

Abstract

More than 30 years have passed since the first description of such a concept as white coat hypertension was presented in the scientific literature, but since then, scientists are paying more and more attention to this condition. White coat hypertension is defined when the blood pressure readings obtained in the doctor’s office meet the criteria for hypertension, but the latter is not confirmed by outpatient or home blood pressure monitoring. Initially, the term was only applied to patients who had not received antihypertensive treatment, but recently this definition has been extended to people who regularly take drugs for lowering blood pressure, and this condition was called uncontrolled white coat hypertension. Some of the world’s most influential organizations in the field of cardiology have not reached a consensus on the definition of white coat hypertension on the background of common criteria, which has affected the differences in blood pressure thresholds according to outpatient monitoring. Quite a few studies in recent years have examined the clinical and prognostic significance of white coat hypertension in terms of its probable effects such as metabolic disorders, subclinical and extracardiac target organ damage, cardiovascular morbidity and mortality, and all-cause mortality. At present, there is no doubt that white coat hypertension is not an innocent condition; however, hypotheses about the prognostic role of this condition and the management of patients with white coat hypertension are still controversial. The question of treating white coat hypertension as a condition remains unsolved and requires further investigation. Today, it is considered most appropriate not to prescribe antihypertensive treatment to persons with office blood pressure at normal or below target levels, but to intensify lifestyle modifications and focus on reduction of cardiovascular risk.