White Coat Hypertension

White coat hypertension (WCH), characterized by transient elevation of SBP of up to 30 mmHg and DBP elevation of up to 20 mmHg, is precipitated by a vigorous sympathetic response in the medical or dental setting. The incidence of WCH is unknown with estimates in the range of 12-50 percent. There is a paucity of information available addressing the number of patients with WCH who eventually develop unequivocal HTN; however, WCH is noted in as many as 20 to 35 percent of patients diagnosed with HTN.12 Many authorities believe that patients with WCH are at risk for major cardiovascular events. Consequently, a referral to a physician is indicated for a thorough medical evaluation to rule out risk factors for cardiovascular diseases and the presence of target-organ damage. Since BP has a reproducible “circadian” profile, suspected WCH in patients with HTN, and no target-organ damage, are candidates for ambulatory blood pressure monitoring (ABPM).12,14