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document
White coat effect detected using self-monitoring of blood pressure at home : comparison with ambulatory blood pressure . The objective of the study was to investigate whether home blood pressure ( HBP ) is a reliable alternative to ambulatory blood pressure ( ABP ) for the detection of the white coat effect ( WCE ) . Hypertensive patients were randomized to measure HBP for 2 weeks or ABP for 24 h. The alternative measurement was then performed . Clinic blood pressure ( CBP ) was measured in the beginning and end of the study . Subjects with a difference of > or = 20 mm Hg systolic or > or = 10 mm Hg diastolic BP between CBP and awake ABP or CBP and HBP , were classified as clinic reactors . A total of 189 patients completed the study ( 79 on stable antihypertensive treatment ) . There was no difference in the magnitude of WCE assessed using the ABP or the HBP method ( mean discrepancy , systolic BP : -1.5 +/- 11.7 mm Hg , 95 % CI -3.2 , 0.2 ; diastolic BP : 0.9 +/- 7.0 , 95 % CI -0.1 , 1.9 ) . A strong association existed between WCE calculated using the HBP or the ABP method ( r = 0.64/0.59 systolic/diastolic , P < .001 ) . The proportion of patients classified as clinic reactors was identical using the HBP or the ABP method ( 25.9 % ) . Agreement between methods in the classification of clinic reactors was found in 147 patients ( 78 % ) . The sensitivity and specificity of the HBP method to classify correctly clinic reactors ( ABP method used as the standard ) were 57 % and 85 % , respectively , whereas its positive and negative predictive value were 57 % and 85 % . These results indicate that HBP is not appropriate as an alternative to ABP diagnostic testing in the detection of WCE . Nevertheless , HBP appears useful as a screening test for the detection of this phenomenon .
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Outcome_Physical
home blood pressure
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Outcome_Physical
blood pressure
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Outcome_Physical
Clinic blood pressure ( CBP )
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Outcome_Physical
WCE
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Outcome_Physical
ABP
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Outcome_Physical
HBP
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Outcome_Physical
systolic BP :
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Outcome_Physical
diastolic BP :
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Outcome_Physical
WCE
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Outcome_Physical
HBP
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Outcome_Physical
ABP
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Outcome_Physical
clinic reactors
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Outcome_Physical
clinic reactors
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Outcome_Physical
HBP
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Outcome_Physical
HBP
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Participant_Condition
Hypertensive
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Participant_Sample-size
189
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Participant_Sample-size
79