The white-coat effect is associated with increased blood pressure reactivity to physical activity

• Published in: Blood pressure monitoring Vol. 7; no. 4; pp. 209 - 213
• Main Authors: Leary, Andrew C, Donnan, Peter T, MacDonald, Thomas M, Murphy, Michael B
• Format: Journal Article
• Language: English
• Published: England 01-08-2002
• Subjects: Activities of Daily Living; Adult; Antihypertensive Agents - therapeutic use; Blood Pressure Monitoring, Ambulatory; Diastole; Female; Humans; Hypertension - epidemiology; Hypertension - physiopathology; Hypertension - psychology; Ireland - epidemiology; Male; Middle Aged; Motor Activity - physiology; Prospective Studies; Stress, Psychological - physiopathology; Systole; Ireland
• DOI: 10.1097/00126097-200208000-00002
• ISSN: 1359-5237

The aim of this study was to test the hypothesis that blood pressure (BP) reactivity to the stress of a clinic visit, the so-called white-coat effect, is associated with increased BP reactivity to physical activity.
Patients referred to our clinic for assessment of hypertension prospectively underwent 24-h ambulatory BP monitoring and simultaneous actigraphy.
The difference between mean clinic BP and mean daytime ambulatory BP was considered to be a measure of the white-coat effect. Presence or absence of a white-coat effect (clinic-daytime difference > 0 mmHg) was added to a mixed model regression of BP on mean activity score for the 10-min interval preceding BP measurement.
The group (n = 421) was heterogeneous in age, gender, mean 24-h BP and use of antihypertensive medications. A total of 259 patients had a systolic white-coat effect; for diastolic BP there were 264. Female patients exhibited a significantly larger white-coat effect. Coefficients for the regressions of both systolic and diastolic blood pressure on physical activity levels were significantly higher in those who had a white-coat effect.
These data suggest increased BP reactivity to activity in those with a white-coat effect. Patients with a prominent white-coat effect may experience greater BP load during normal daily activities as a consequence of increased BP reactivity. In patients with white-coat hypertension, this may contribute to target-organ damage.