White coat hypertension is defined as elevated office blood pressure with normal out-of-office blood pressure readings, and white coat effect is defined as elevated office blood pressure in a patient treated for hypertension with normal out-of-office readings. The risks associated with white coat hypertension and white coat effect are unclear. In a meta-analysis of 27 studies comparing cardiovascular outcomes of patients with white coat hypertension or effect versus normotensive patients, white coat hypertension was associated with an increased risk of cardiovascular and all-cause mortality, and a non-significantly higher risk of all cardiovascular events.
In contrast, white coat effect was not associated with increased risk. While we do not initiate pharmacologic treatment for white coat hypertension, lifestyle modification should be encouraged and out-of-office blood pressure…
