White coat hypertension is not a benign entity: a cross-sectional study at a tertiary care hospital in Pakistan.

OBJECTIVES To determine the frequency of White Coat Hypertension in patients undergoing ambulatory blood pressure monitoring at a tertiary care center and to compare ambulatory blood pressure profiles of normotensives, white coat hypertensives and hypertensives. METHODS A descriptive cross-sectional study was conducted which included all adult patients undergoing ambulatory blood pressure monitoring over a 3-year period. Those patients with incomplete data, less than 85% successful BP readings and inadequate number of daytime and nighttime readings were excluded from the study. The data on ambulatory blood pressure monitoring comprised of demographics, blood pressure, pulse pressure and mean arterial pressure readings at every 30 minutes interval and also a graphical representation of patients' 24-hour blood pressure recording. SPSS was used for data analysis. Chi-square test and analysis of variance (ANOVA) was used for qualitative and quantitative variables respectively. RESULTS A total of 277 patients with a mean age of 48.98 +/- 17.52 years were included. There were 189 (58%) males included in the study. Out of the total, 46 (16.6%) patients had White Coat Hypertension, 59 (21.3%) were Normotensive and 172 (62.1%) had Hypertension. The mean age of Normotensives was 40.80 +/- 14.11 years, White Coat Hypertensives was 37.72 +/- 14.58 years and Hypertensives was 54.80 +/- 16.76 years (p <0.001). The overall average Systolic Blood Pressure in Normotensives was 118.69 +/- 6.61mm Hg in White Coat Hypertensives 120.57 +/- 6.71 mmHg and in Hypertensives it was 131.18 +/- 13.14mm Hg (p<0.001). The overall systolic load in Normotensives was 12.98 +/- 15.21, White Coat Hypertensives 15.86 +/- 14.12 and Hypertensives 41.71 +/- 28.21 (p value<0.001). The Mean Arterial Pressure in Normotensives was 90.17 +/- 5.02 mm Hg, in White Coat Hypertensives 90.17 +/- 5.08 mmHg and in Hypertensives it was 96.08 +/- 9.21mm Hg (p <0.001). The average Pulse Pressure in Normotensives was 43.56 +/- 6.29, White Coat Hypertensives 46.20 +/- 6.49 and in Hypertensives it was 54.65 +/- 12.86 (p <0.001). CONCLUSION Our study has shown a frequency of White Coat Hypertension, which is similar to many populations globally. All parameters of hypertension are more prevalent in this group compared to normotensives, which signifies that White Coat Hypertension is not a benign entity in our population and it needs to be closely followed for development of Hypertension and other cardiovascular complications.