The study of prevalence and determinants of white-coat hypertension in medical personnel: A prospective study

Abstract

Context: White-coat hypertension (WCH) has variable prevalence with prognostic significance, and ambulatory blood pressure monitoring (ABPM) is a reliable method for its identification. Assessment of WCH is necessary to prevent overtreatment. Aims: The objective was to study the prevalence and determinants of WCH in medical personnel. Settings and Design: A cross-sectional observational study was performed on young medical students. Duration was 23 months. Subjects and Methods: A total of 354 medical students were screened for hypertension, and those who were found hypertensive were then subjected to ABPM using CONTEC-06C monitor. Baseline characteristics were compared between white-coat hypertensive and true hypertensive groups. Hamilton Anxiety Rating Scale was used for anxiety assessment. Patients with target organ damage were excluded from the study. Statistical Analysis: Continuous groups were compared by independent Student s t-test, whereas categorical groups were compared using Chi-square test. P < 0.05 was considered as statistically significant. Results: Among 50 hypertensive patients on ABPM, the prevalence WCH was 66% and true hypertension was 34%. Mild anxiety (Hamilton anxiety rating score (HRS) <18) was found to be significantly high (54.5%) among WCH group, while severe anxiety (HRS 25–30) was associated with true hypertensive group (41.2%). A significantly high reverse dipping is found in hypertensive group patients as compared to WCH group (9.1% vs. 23.5%; P = 0.03). Overall, nondippers were found to be in highest percentage in the study. Conclusions: WCH is high in young population, especially among medical professionals. The prevalence of WCH is 66% which is significantly high as compared to the literature available. Reverse dipping on ABPM is strongly associated with true hypertension.