Key result
Extreme white coat effect in a 63-year-old woman caused systolic BP >200 mmHg during medical contact but hypotension when unobserved, possibly contributing to a subsequent hemorrhagic stroke.
Case Report (n=1)
This case highlights the clinical challenge of managing extreme white coat hypertension, where standard antihypertensive therapy may cause unobserved hypotension and extreme blood pressure fluctuations can lead to severe complications such as hemorrhagic stroke.
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Clinicians should verify extreme office hypertension with out-of-office BP monitoring; this case leaves open its contribution to hemorrhagic stroke.
In this report, we present a challenging case of a 63-year-old Caucasian woman with an extreme stress response to blood pressure (BP) measurements. Office- and ambulatory BP measurements consistently found systolic BP above 200 mmHg. However, antihypertensive medication made her dizzy and extremely unwell, and she could barely tolerate treatment with a moderate dose of angiotensin-converting enzyme (ACE) inhibitor. Finger-cuff-based measurements (Finapres Finometer®) revealed extreme hypertension in relation to contact with medical professionals, but hypotension when the patient was seated alone unobserved. Months after, the patient suffered a hemorrhagic stroke possibly related to her extreme BP-fluctuations in stressful situations.
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Nyvad et al. (2019) conducted a case report in Extreme white coat effect (n=1). Contact with medical professionals (white coat effect) vs. Seated alone unobserved was evaluated on Blood pressure fluctuations and hemorrhagic stroke. Extreme white coat effect in a 63-year-old woman caused systolic BP >200 mmHg during medical contact but hypotension when unobserved, possibly contributing to a subsequent hemorrhagic stroke.
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