Decoding white coat hypertension

Figure 1. Normal 24 h ambulatory blood pressure recording. In all the figures, the simultaneous systolic and diastolic blood pressure values are connected by vertical lines. The blue line within the verticals is the mean blood pressure. The recorded pressure in mmHg is noted on the vertical axis. At the time of recording, recognized normal values, represented by light horizontal lines, were 135 mmHg systolic and 85 mmHg diastolic during the daytime and 120 mmHg systolic and 70 mmHg diastolic during sleep. The 24 h time of recording is noted on the horizontal axis. The solid black horizontal bar represents the sleep period.

Figure 2. The four time segments of the recording.

Figure 3. The hospital-induced bimodal blood pressure fall of the white coat effect.

Figure 4. The pressure elevation from exercise (E) and strenuous activity (A).

Figure 5. White coat hypertension with superimposed essential systolic hypertension reflected in the rising pressure in the afternoon and evening.

Figure 6. Essential hypertension with an initial classical white coat configuration.

Figure 7. The night-time dip. A classical white coat pattern during day time with a normal sleep time pressure dip of 20 mmHg.

Figure 8. White coat hypertension with a blunted night time dip. The recorded pressure in mmHg is noted on the left vertical axis. The pulse pressure in beats per minute is noted on the right vertical axis. The 24 h time of recording is noted on the horizontal axis. The solid black horizontal bar represents the sleep period.

Figure 9. Similar percentage of blunted nighttime dippers in medicated but uncontrolled essential hypertensives, medicated controlled hypertensives, and medicated white coat hypertensives. EH: Essential hypertensives; CH: Controlled hypertensives; WCH: White coat hypertensives.

Figure 10. Elevated nighttime blood pressure and pulse rate. The recorded pressure in mmHg is noted on the left vertical axis. Right axis shows the recorded pulse rate in beats per minute. Horizontal axis displays the 24 h time with black bar indicates the sleep period.

Figure 11. Pressure and pulse rate rise during a nightmare at 7:30 am.

Figure 12. The “morning surge” upon awakening.