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Differing Perspectives on White Coat Hypertension

Thomas G. Pickering, MD, DPhil
Arch Intern Med. 1992;152(4):691-692. doi:10.1001/archinte.1992.00400160009001.
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One of the more consistent findings to emerge from studies that have compared clinic (or office) and ambulatory blood pressure values in hypertensive patients has been that the agreement between the two is not very close and that there are a substantial number of patients in whom the clinic pressure overestimates the pressure at other times.1 This has led to the concept of white coat hypertension, which may be defined as a persistently elevated clinic pressure together with a normal ambulatory pressure.

In a carefully conducted population-based study reported in this issue, Pearce et aI2 come to quite different conclusions, namely, that clinic blood pressure is a good predictor of blood pressure at other times and that white coat hypertension is uncommon. If this is true, it has major implications for the use of ambulatory blood pressure monitoring in clinical practice. The rationale underlying the use of clinic


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