The Learning Blog

A Brazilian study found that there is an increased risk for microvascular complications in diabetic patients having white-coat hypertension (WCH).

Dr. Caroline Kramer and colleagues at the Hospital de Clinicas de Porto Alegre identified 46 diabetic patients who had normal ambulatory blood pressures but had elevated BP in the clinic.

These subjects were compared with 117 people with normal BP for both ambulatory and clinic settings.  The study found that patients with WCH had increased risk for both diabetic nephropathy and diabetic retinopathy.

The group advised not to consider WCH as a harmless condition and patients with WCH must be treated accordingly.

Comment:

As was described above, white coat hypertension is a phenomenon when an individual will present with a high blood pressure while in a physician’s office, but will have a normal blood pressure outside the clinic. It is usually attributed to possible stress or anxiety prior to or during the taking of the blood pressure.

Personally, I have seen a few patients with this condition though I’m not going to conclude immediately that this is a rare finding. Some patients would present to the clinic as having a high blood pressure but would also tell me that they have a normal BP at their home or in some other place. What I recommend is to have them keep a diary of their BP if I think that they need to be monitored. Unless a patient is able to afford one, an ambulatory blood pressure machine is not really necessary, but a diary that has the BP reading, the time, date, and place where they had their reading taken and who took them is enough.

A good advise is the preparation of the patient prior to the BP taken. Relax for 5 minutes, no caffeine-containing beverages,  empty bladder and no heavy meal.

In this study, the message is clear: don’t take WCH for granted. Though we may attribute this to a possible “psychological” factor, WCH can be a force to reckon with especially to people with diabetes. So regular monitoring of BP, sugar levels, and urinalysis are important for this particular group of diabetic patients.

Image from Veer.

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