Pulse wave velocity, central aortic pressure, and arterial reflection waves in white coat hypertension

White coat hypertension (WCH) is defined as office blood pressure (BP) of >140/90 mmHg but otherwise normal BP in untreated individuals. 1---6 BP is assessed ideally by ambulatory BP monitoring (ABPM), by self-measurement on at least three occasions, and more than once by office measurement.WCH, first described by Pickering in the 1980s, 7 should not be confused with the white coat effect or alerting reaction, 8 a rise in BP in the presence of a physician that occurs in normotensives as well as hypertensives, irrespective of whether they are under antihypertensive therapy. 9or many authors, the alerting reaction and WCH are expressions of the same pathophysiological phenomenon. 10---12 They are distinguished in two ways.Firstly, the mechanism behind the alerting reaction may not be the same as that underlying WCH, as pointed out by Pickering, who suggested that the alerting reaction may be an adaptive physiological response by the sympathetic nervous system. 9Secondly, WCH is only found in untreated individuals.In their study published in this issue of the Journal, Almeida et al. 13 restrict the diagnosis of WCH to untreated individuals.The requirement for subjects to be untreated