White coat hypertension: understanding the concept and examining the significance

Because the concept of white coat hypertension is evolving, a variety of definitions appear in the literature. There has also been continuing debate as to whether white coat hypertension is a benign clinical condition or is associated with increased hypertensive complications. This paper summarizes and evaluates the literature on white coat effect/hypertension, with a focus on the following aspects of the concepts: (1) alternative definitions, (2) prevalence and predictors, (3) prognostic significance, and (4) implications for clinical practice. The evidence suggests that white coat hypertension is not a harmless phenomenon. It is frequently associated with increased target-organ damage and often coexists with other cardiovascular risk factors. The extent of the presence of other risk factors may determine the risks associated with white coat hypertension. It is important for clinicians to understand the concept, learn to diagnose it properly, and develop strategies for evaluating risk levels so that patients receive the proper treatment.