Hypertension white coat , better known as white mantle syndrome , is a phenomenon in which patients show blood pressure levels above the normal range, in a clinical setting, although they do not show it in settings other. It is believed that this phenomenon is caused by anxiety experienced during a clinic visit.
Outpatient blood pressure during the day of the patient is used as a reference because it takes into account the usual daily stress level. Many problems have arisen in the diagnosis and treatment of hypertension white coat.
The term " masked hypertension " can be used to describe contrasting phenomena, in which the patient's blood pressure is above the normal range during everyday life, although not above the normal range when the patient is in a clinical setting.
Video White coat hypertension
Diagnosis
In the study, hypertension white coat can be defined as the presence of mean blood pressure hypertension defined in clinical settings, although not present when the patient is at home.
Diagnosis is made difficult as a result of unreliable actions taken from conventional detection methods. This method often involves interfacing with health care professionals and often the result is tarnished by a list of factors including variability in individual blood pressure, technical inaccuracies, patient anxiety, recent ingestion of pressor substances, and speech, among many other factors. The most common measure of blood pressure is taken from a non-invasive instrument called a sphygmomanometer. "A survey showed that 96% of primary care physicians typically use cuff sizes too small," adding to the difficulty in making the diagnosis of information. For this reason, hypertension of a white coat can not be diagnosed with a standard clinical visit. This can be reduced (but not eliminated) by automatic blood pressure measurement for 15 to 20 minutes in the quiet part of the office or clinic.
Patients with white coat hypertension show no signs of dither and their increased blood pressure is often not accompanied by tachycardia. This is supported by repeated studies showing that 15% -30% of those suspected of having mild hypertension as a result of clinical or office tape display normal blood pressure and no unusual response to pressure stimuli. These people do not exhibit specific characteristics such as age which may indicate a higher susceptibility to hypertension white coat.
Outpatient blood pressure monitoring and self-measurement of patients using home blood pressure monitoring are being increasingly used to distinguish them by hypertension of a white coat or experience the effects of white hair from those with chronic hypertension. This does not mean that this method is without error. The daytime ambulatory value, although taking into account the pressures of everyday life when taken during the patient's daily routine, is still susceptible to daily variable effects such as physical activity, stress and sleep duration. Ambulatory monitoring has been found to be a more practical and reliable method of detecting patients with hypertension in white coats and for predicting target organ damage. Even then, the diagnosis and treatment of hypertension white coat is still controversial.
Recent studies have shown that monitoring blood pressure at home is as accurate as 24 hour ambulatory monitoring in determining blood pressure levels. Researchers at the University of Turku, Finland studied 98 patients with untreated hypertension. They compared patients who used blood pressure devices at home and those who took a 24-hour ambulatory monitor. Researcher Dr Niiranen said that "home blood pressure measurements can be used effectively to guide anti-hypertensive treatment". Dr Stergiou added that blood pressure tracking at home "is more convenient and also less expensive than outpatient monitoring."
The use of respiratory pattern has been proposed as a technique to identify hypertension of white coat.
In one Turkish study of 438 consecutive patients, 38% were normotensive, 43% had hypertension white coat, 2% had hypertensive cover, and 15% had sustained hypertension. Even patients taking drugs for normotensive sustained hypertension at home can show hypertension of a white coat at the office.
Maps White coat hypertension
Implications for treatment
In general, individuals with hypertensive white coats have a lower morbidity than patients with sustained hypertension, but morbidity is higher than clinically normotensive. However all published trials of the consequences of high blood pressure and cure benefits, are based on a one-time measurement in a clinical setting rather than the generally lower readings obtained from the ambulatory recordings.
Debate and conflicting ideas revolve around whether or not it would be feasible to treat white-coat hypertension, as there is still no convincing evidence that the increase in temporary blood pressure during office visits has adverse health effects.
In fact, many cross-sectional studies show that "organ-target damage (as exemplified by left ventricular hypertrophy) is less in white patients with hypertensive hygiene than in sick hypertensive patients even after provision is made for differences in clinical pressure". Many believe that patients with "white jacket" hypertension do not require very small doses of antihypertensive therapy because they can lead to hypotension, but should be cautious as patients may show signs of vascular changes and may eventually develop hypertension. Even patients with well-established controlled hypertension based on home blood pressure monitoring may experience high readings during office visits.
References
Source of the article : Wikipedia
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