Talk:White coat hypertension

this article currently seems fairly certain in promoting WCH as being benign. It cites from Pickering who seems to have written a large number of articles (according to PubMed search) unfortunately mostly to journals not abstracted by PubMed. There are several issues here both for WCH and home blood pressure recordings:

• Yes WCH might mean that the patient is not having a consistent high reading as determined in the clinic, over aggressive treatment would of course result in hypotension (low BP outside of the clinic).
• But how certain are we in reporting WCH as benign and not needing treatment - the fact that such patients can mount such a response to a stressful stimuli distinguishes them from those normotensives who despite being under enormous personal stress (eg bereavement, loss of job, or concerns for health) nether-the-less maintain a normal BP reading.
• It is generally true that home readings are 5-10mmHg lower than clinic readings for the majority of patients (i.e. excluding those with WCH). But the studies looking at the risks of higher blood pressures and hence the benefits of treating were established from clinic readings. So a patient seeming above treatment-instigation level of 150mmHg, with a clinic reading of 152mmHg, is merely confirming the need to start (gentle low-dose) therapy if their home readings are consistently around 148mHg.
• Ambulatory blood pressure reading (automated machine like a walkman personal player strapped to waist) that takes BP every 15-30min throughout the course of a day and night is often better than repeated single home readings. Some patients get stressed over what they will find their self-taken home readings will be, the ambulatory monitors do not display the reading obtained and the patient has little time to get stressed over having a single reading, and obviously even less so with the night time readings (although often a disturbed nights sleep for the duration of the test).

The following additional references may be helpful, the later ones in particular show debate not closed on WCH being innocent:

• Little P, Barnett J, Barnsley L, Marjoram J, Fitzgerald-Barron A, Mant D (2002). "Comparison of agreement between different measures of blood pressure in primary care and daytime ambulatory blood pressure". BMJ. 325 (7358): 254. PMID 12153923.{{cite journal}}: CS1 maint: multiple names: authors list (link) - Ambulatory is better for diagnosing hypertension
• Kario K, Pickering T (1999). "Survey of white coat hypertension. Definition differs from others". BMJ. 318 (7182): 535. PMID 10024273. - defining WCH correspondence debate between Pickering and original paper's authors
• "White coat hypertension is associated with risk of left ventricular hypertrophy". BMJ. 317 (7158): C. 1998. PMID 9721143. - commentary on:
  Muscholl M, Hense H, BrÃckel U, DÃring A, Riegger G, Schunkert H (1998). "Changes in left ventricular structure and function in patients with white coat hypertension: cross sectional survey". BMJ. 317 (7158): 565–70. PMID 9721112.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• Mancia G, Facchetti R, Bombelli M, Grassi G, Sega R (2006). "Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure". Hypertension. 47 (5): 846–53. PMID 16567588.{{cite journal}}: CS1 maint: multiple names: authors list (link) - which concludes "white-coat hypertension and masked hypertension, both when identified by office and ambulatory or by office and home BPs, are not prognostically innocent. Indeed, each BP elevation (office, home, or ambulatory) carries an increase in risk mortality that adds to that of the other BP elevations."

For now I conclude with the title of another paper this year (sadly no abstract available in PbMed) : McLean M, Naidoo S (2006). "The white coat in clinical practice - the debate rages on!". S Afr Med J. 96 (5): 402–6. PMID 16751911. David Ruben ^Talk 01:10, 13 June 2006 (UTC)

Size of the effect

There's no indication in the article about the possible size of this effect. Have there been any studies on this? Jammycakes 13:43, 10 July 2006 (UTC)

Ethical implications

If a doctor has a patient who smokes, or drinks coffee, or is a little bit overweight, and has elevated blood pressure, there are likely to advise them to improve their health and cut down on their bad habits rather than mention anything like white coat hypertension.

In fact it may be the single most useful placebo phenomenon in encouraging people to improve their general health, although depending on your definition of ethical such practices might be unethical.

—Preceding unsigned comment added by 12.41.40.20 (talk • contribs) 23:16, 13 November 2006

If you are talking about a doctor who knows or believes that his/her patient is exhibiting this syndrome, but chooses to present it to the patient as 'regular' hypertension because that will be 'good for the patient', there's certainly an ethical question. Although occasions can be envisaged in which it might be necessary, lying to a patient should always raise an ethical dilemma. In the particular case of WCH, the doctor ought also consider the possibility that using exaggerated readings to scare the patient into a better lifestyle might, in the case of an individual prone to stress, have the self-fulfilling effect of helping to drive up the patient's blood pressure. Hardly compatible with the principle 'First do no harm'. Grubstreet (talk) 08:19, 17 July 2009 (UTC)

Contradiction between title and lede

If white coat hypertension is "more commonly known as white coat syndrome", as the intro paragraph claims, why isn't that the title? I'm sure there is some Wikipedia guideline but the effect is needlessly confusing. Bulbubly (talk) 23:59, 25 August 2021 (UTC)

Expand scope to hospital anxiety in general

This seems like something that could be more broadly present in medicine. Symptoms that are caused or exacerbated by the patients acknowledgement of the severity of the situation. Or preicived severity when it comes to things separate to whatever the actual reason for the patient seeing medical staff.

For example of my point I will give examples.

1. Critical condition So the guy could have a serious injury or something of that nature, If they are struggling to remain calm over needing hospital treatment.

Though that one would be infeasible to distinguish from other sources of anxiety, such as fear of financial burden post treatment or ambulance costs.

2. Vulnerability of being at hospital or being tested.

Someone can be worried they will find something very bad and that might up their anxiety. If someone is thought to be after the inheritance or something of that nature they might think perhaps the doctors might have been talked into lowering standards or turning a blind eye.

If this is happening or not there are some people who believe the straw man arguments about euthanasia and could be afraid of that or if you are on drugs you may face legal issues and that could affect your presentation towards staff especially if there is a police presence.

3. Fear of malpractice, overdiagnosis or unnecessary treatment.

There are scenarios where the hospital or clinic either can't communicate with a conscious and aware patient or the requirement for the patients consent has been waived.

If someone has been drugged or is believed to be having a psychiatric problem or has some obstacle to communicating with the the staff.

This would only be white labcoat syndrome realated if we are taking about strictly the reaction to being in the clinic.

If you have been spiked or through means unknown to you become high or under the influence of something that alters your presentation you have the fear of what is going to happen next and someone who believes they were drugged might alter their behaviour to seem more "normal" but achieve the opposite.

One could just be very distressed over the psychological effects of being detained so things that would also be applicable if the subject was being detained as a criminal suspect instead plus distress over having less rights than one.

Going beyond that it would stop being about the clinical aspects of it and more the legal aspect and reaction thereof and the affects of institutionalisation plus anything after the fact except for distress solely caused by the fact the subject is a patent at all regards of if they have anything or not.

Maybe we can get a list of overlapping things so the article can help us tell the difference, most people are not in hospital because they want to be so I think the concept could be more useful if it covered symptoms that are caused/exacerbated by hospital anxiety. 109.148.254.157 (talk) 21:51, 1 January 2023 (UTC)