White coat hypertension
Your recent article on white coat hypertension (“White coat hypertension presents an elusive challenge,” ACP Internist, October 2012) offers the opportunity to raise two issues that have nagged me over the years.
First, if a patient's blood pressure rises as a stress response to being examined by a physician, could this signify that the patient might indeed spend a good part of the day with elevated blood pressure if he works a stressful job and drinks a lot of caffeine? And if the “gold standard” is a quiet, resting blood pressure reading in the morning, to what extent would that disagree with a 24-hour reading in this patient?
Second, I would venture to say that much of the research on hypertension was conducted using readings taken by physicians and nurses wearing white coats. To what extent is “white coat hypertension” baked into the studies upon which we depend?
Richard Gayes, MD, ACP Member
Oak Park, Ill.