White Coat Uncontrolled Hypertension in Teleconsultation: A New and Frequent Entity

• Published in: High blood pressure & cardiovascular prevention Vol. 29; no. 2; pp. 155 - 161
• Main Authors: Barochiner, Jessica, Marín, Marcos J., Janson, Jorge J., Conti, Patricia R., Martínez, Rocío, Micali, Gabriel, Conte, Isabel E., Plazzotta, Fernando
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.03.2022; Springer Nature B.V
• Subjects: Antihypertensive Agents - adverse effects; Antihypertensives; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Body mass index; Cardiology; Cerebrovascular disease; COVID-19; Creatinine; Diabetes; Female; Health care expenditures; Health risks; Humans; Hypertension; Hypertension - diagnosis; Hypertension - drug therapy; Hypertension - epidemiology; Male; Medicine; Medicine & Public Health; Middle Aged; Original; Original Article; Pandemics; Patients; Personal health; Pharmacotherapy; Remote Consultation; Standard deviation; White Coat Hypertension - diagnosis; White Coat Hypertension - drug therapy; White Coat Hypertension - epidemiology; Teleconsultation; Home blood pressure monitoring; High blood pressure; White uncontrolled hypertension; Masked uncontrolled hypertension
• ISSN: 1120-9879; 1179-1985
• DOI: 10.1007/s40292-021-00498-y

Introduction Cardiovascular risk seems not to be greater in patients with white coat uncontrolled hypertension (WUCH) than in patients with sustained blood pressure (BP) control. Therefore, its detection is important to avoid overtreatment. The COVID-19 pandemic determined a massive migration of hypertension consultations from the face-to-face modality to teleconsultations, and it is unknown whether WUCH exists in this context. Aim We aimed to evaluate the prevalence of WUCH through home BP monitoring (HBPM) in treated hypertensive patients evaluated by teleconsultation. Methods We included treated hypertensive patients that owned a digital BP monitor. During teleconsultation, patients were asked to perform two BP measurements and then a 7-day HBPM, using the same device. Patients were classified as having WUCH if BP was ≥ 140 and/or 90 mmHg in teleconsultation and < 135/85 mmHg on HBPM. The prevalence of WUCH and its 95% confidence interval were estimated. One-way ANOVA, the Chi-square test or Fisher’s exact test were used to compare the characteristics of these patients with the other groups. Results We included 341 patients (45.2% male, mean age 62.3 years). The prevalence of WUCH was 33.1% (95% CI 28.3–38.3%). Significant differences were found in terms of age, the number of antihypertensive drugs and the use of calcium channel blockers, all lower in the WUCH group as compared with the groups with elevated BP on HBPM. Conclusion WUCH exists in teleconsultation and is very frequent. It can be easily detected though HBPM, thus avoiding overmedication, and its potential impact on side-effects and health costs.