Is There Tension in Hypertension?-Reply

In Reply. —Drs Gross and Mann discuss the possibility of white coat hypertension confounding the results of our study, particularly among anxious individuals. The concept of white coat hypertension was not established until the mid 1980s, so it is possible that some individuals in this study who were given medication by their private physicians for hypertension had white coat hypertension. In addition, all blood pressures recorded for the Framingham Study were performed by the examining physician; therefore, it is possible that elevated clinic blood pressures were also attributable to white coat hypertension. By using the cutoff for hypertension traditionally used by the Framingham Study (160/95 mm Hg), we avoided the milder elevations of blood pressure that may have occurred. However, previous studies have not found evidence that trait anxiety plays a role in white coat hypertension.¹,²In addition, white coat hypertension is more prevalent in women,³and no