What Is White Coat Hypertension?  

Hypertension refers to high blood pressure, defined as a systolic blood pressure of >130 mm Hg, a diastolic blood pressure of >80 mm Hg, or requiring blood pressure-lowering medication(s).¹ White coat hypertension is a condition in which an individual experiences high blood pressure only in a medical office setting, but not at home.² 

The European Society of Hypertension more precisely defines it as individuals with a blood pressure reading for at least 140/90 mm Hg in a medical office setting, while the average 24-hour blood pressure is less than 130/80 mm Hg.³ The American Heart Association has a slightly different cutoff, defining white coat hypertension as blood pressure of 130/80 mm Hg or above in a medical office setting, while home or ambulatory blood pressure is less than 130/80 mm Hg.  

How Common Is White Coat Hypertension?  

White coat hypertension is a common condition, affecting approximately 15-30% of the population.^2–4 It is seen more frequently in certain populations, including older adults, pregnant women, and those with elevated blood lipid levels, among others.^3,4

Is White Coat Hypertension a Real Risk?

Hypertension is a well-known leading cause of cardiovascular disease (CVD; diseases of the heart and blood vessels) and death.⁵ Research in the past had been inconclusive about whether white coat hypertension carries the same risk to health. However, recent discoveries have raised alarms that white coat hypertension can raise risks of morbidity when compared to individuals with normal blood pressure.^2,3 Studies show that white coat hypertension is related to significantly increased risk of it becoming sustained hypertension in the future.³ Additionally, it is associated with unfavorable metabolic risk factors and increased risk of future cardiovascular conditions and events such as atherosclerosis (ie, hardening of arteries from build-up of cholesterol plaques) and heart attacks.^2,3

For instance, a large study on a randomized sample representative of Italian population found that individuals with white coat hypertension showed less favorable changes to cardiac structure when compared to individuals with normal blood pressure, but more favorable cardiac structure when compared to those with sustained hypertension.⁶ This study first demonstrated that true underlying physiological differences may mark white coat hypertension, raising alarms that it may not be as harmless as once seen. A 10-year follow-up of the study sample also found that those with white coat hypertension developed sustained hypertension at a significantly higher rate than those with normal hypertension, showing that white coat hypertension is a real cardiovascular risk.⁷