Prevalence of and causative factors in white-coat hypertension: results of the Japanese Multicenter Study on Barnidipine with Ambulatory Blood Pressure Monitoring

The white-coat phenomenon is manifested as a transient elevation in blood pressure during a visit to a medical institution. Several studies have suggested that sympathetic nervous activity is involved in the white-coat phenomenon. In the Japanese Multicenter Study on Barnidipine with Ambulatory Blood Pressure Monitoring (J-MUBA), clinic blood pressure, gender, and age were independent determinants of the severity of the white-coat phenomenon. The prevalence of white-coat hypertension differs depending on patient age, blood pressure, or definition of the normal range of home or ambulatory blood pressure. Among patients enrolled in J-MUBA, the frequency of white-coat hypertension ranged from 2% to 21%. White-coat hypertension may be the first step in the development of persistent hypertension. However, blood pressure levels normalize in some patients with white-coat hypertension and therefore they require follow-up. Data on the prognosis of these patients are limited. Cardiovascular morbidity and mortality rates appear to be low in white-coat hypertension, although some studies report that it is associated with metabolic abnormalities such as high plasma lipid levels. Risk factors other than blood pressure should be evaluated, together with the initiation of lifestyle modifications. Patients with white-coat hypertension do not appear to benefit from anti hypertensive therapy, as demonstrated by the lack of effect of barnidipine on normal blood pressure in J-MUBA. However, further large-scale studies are needed to confirm these results. Blood Press Monit 6 (suppl 2):S17-S23 (C) 2001 Lippincott Williams Wilkins.