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White Coat Syndrome
Q1. What is the definition of high blood pressure?
According to the latest guidelines of the American Heart Association, normal blood pressure is defined as systolic blood pressure below 120 and diastolic blood pressure below 80. It is already stage 2 hypertension if the reading is over 140/90, and hypertensive crisis if the systolic and diastolic blood pressure levels are higher than 180 and 120 respectively.
Q2. What is white coat syndrome?
In short, one may have white coat syndrome with a home reading below 140/90 and a clinic reading above 140/90. The risk of hypertension increases significantly if the clinic reading is above 160/100, which should not be considered as mere white coat syndrome. In general, home systolic (upper) and diastolic (lower) blood pressures are 10mmHg and 5mmHg lower than at clinic respectively.
Q3. What is the function of 24-hour ambulatory blood pressure monitoring?
24-hour ambulatory blood pressure monitoring can achieve several purposes. Not only can it diagnoses or refutes white coat syndrome but also monitors the effectiveness of blood pressure treatment for hypertensive patients. The risk of cardiovascular and cerebrovascular diseases increases if hypertensive patients have non-dipping blood pressure at night or blood pressure surge in the morning. 24-hour ambulatory blood pressure monitoring can help pinpoint the health risks associated with blood pressure, so that doctors can adjust the dosage of blood pressure medications or reschedule medications for use before bedtime. It can also provide doctors with additional heart rate data. A research showed that the risk of acute myocardial infarction will rise by 10% if the resting heart rate increases by 10 beats per minute.
Q4. Is white coat syndrome really a “benign” condition? Is it OK to leave it unattended?
A meta-analysis of 27 studies on 25,786 patients with white coat syndrome published in 2019 by US researchers found that it can increase the risk of cardiovascular diseases by 36% and double the mortality risk of cerebrovascular diseases. White coat syndrome is not something to be taken lightly.
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