Magnitude of the white-coat hypertension in the community pharmacy

Background: White coat hypertension (WCH), a high blood pressure recorded in the clinic with normal ambulatory blood pressure monitoring (ABPM) or home BP measurement (HBPM) using automated devices, is a relatively common observation in hypertensive subjects and the general population. The presence of white-coat effect (WCE) in the community pharmacy is not clear. Objective: To investigate the prevalence and possible causes of WCH in the community. Design: A comprehensive patient history and physical exam was conducted for each subject. All subjects over 45 years old were monitored for community pharmacy blood pressure (BP), home blood pressure, and received blood sampling. Results: In total, 1838 subjects (mean age 66±10 years) were enrolled in the study. Of that, 790 (43%) had normal blood pressures, 183 (1%) had masked, of whom 460 (25%) had white-coat hypertension, and 570 (31%) had sustained hypertension. Patients with white coat hypertension were older, had a higher body mass index, waist-hip ratio, higher office SBP, higher DBP, and higher albumin clearance ratio (ACR) (p<0.001 for all). Multivariate analysis showed that age [odds ratio (OR) 1.029, 95% confident interval (CI) 1.001-1.057, p=0.04], office SBP (OR 1.145, 95% CI 1.119-1.172, p<0.001), and office DBP (OR 1.080, 95% CI 1.047-1.114, p<0.001) could predict patients with white coat hypertension. Between 1 year follow up, 2% (16/790) of subjects who were previously normotensive demonstrated sustained hypertension and 10% (47/460) of subjects with white coat hypertension demonstrated sustained hypertension (p<0.001).