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White coat syndrome

 

Quite often - during the examination in the doctor's office - the patient displays white coat syndrome in the measurement of pressure: in the medical institution, it jumps, although the patient does not complain about the increased pressure, does not have any hypertonic symptoms and, moreover, the level of his BP in the usual situation normal…

Epidemiology

According to the results of studies conducted in foreign clinics, white coat syndrome manifests itself in 70-73% of patients with diagnosed arterial hypertension.

Causes of the white coat syndrome

If a person turns to doctors, it means that there are problems with health, which disturb him. Most people associate hospitals and clinics with illness. And the doctors themselves explain the causes of the white coat syndrome with excitement and anxiety (even manifestly not manifested), involuntary state of tension and anxiety when visiting medical institutions. In general, this situation is close to stressful: patients are shy of exposure, afraid of possible painful procedures and poor diagnosis.

Risk factors

All specialists note such risk factors for the emergence of this syndrome as age and excess weight; some add to this list excessive cholesterol in the blood, cardiopathy (in particular, ischemia of the heart), as well as the presence of an anamnesis of diabetes.

There is an opinion that even a temporary increase in blood pressure, that is, a white lab coat syndrome when measuring pressure, can mean an increased threat to health.

Pathogenesis

The pathogenesis of this syndrome is directly related to humoral and vegetative neuroregulation of the tone of the vascular system. At the slightest stress (and for many, going to the doctor is close to jatrophobia), the synthesis of the pituitary hormone corticotropin (ACTH) is increased. Corticotropin stimulates the production of catecholamines - hormones, mediators of adrenaline, norepinephrine and dopamine, as well as the hormone of the cortex of the adrenal cortisol. And further - due to the vasoconstrictive effect of all these hormones - the narrowing of the blood vessels occurs, resulting in an increase in blood pressure.

And since the white coat syndrome, as a rule, manifests itself at every visit to the doctor, this indicates that it is a concrete psychosomatic response to a specific situation.

Symptoms of the white coat syndrome

And even patients taking antihypertensive drugs on an ongoing basis, can show symptoms of white coat syndrome: increased blood pressure when it is measured.

And more often than normal, the index of systolic (upper) pressure (that is, not 110-120, but 140-150 mm Hg) is higher than that of diastolic pressure.

This syndrome is observed in 32-35% of people who came to the medical institution, who do not have problems with pressure. At the same time, 15% of patients actually have arterial hypertension. However, in almost 20% of patients this syndrome is mistaken for hypertensive disease (refractory hypertension) - with the administration of drugs to stabilize blood pressure.

White coat syndrome in pregnancy

The usual phenomenon and white coat syndrome in pregnancy, when all the body systems function in an altered mode. According to some reports, the total prevalence of this syndrome in pregnancy is about 32%. At half of future mothers, the syndrome persists throughout gestation and does not affect their condition in any way.

However, it should be borne in mind that almost 40% of pregnant women are characterized by a true increase in blood pressure (benign gestational hypertension), which, as the duration of pregnancy increases, may result in late toxicosis of pregnancy with very high blood pressure.

With a more serious problem - preeclampsia, which can progress to eclampsia, which threatens the life of the mother and fetus - according to WHO statistics, approximately 8% of pregnant women face.

Complications and consequences

The consequences and complications of this syndrome are the development of hypertension and cardiac diseases. A higher risk is for those whose blood pressure is higher. In addition, in patients with white-coat syndrome, the risk of developing cardiovascular diseases associated with fatalities increases by 1.9 times.

Diagnostics of the white coat syndrome

Since the only symptom of the white coat syndrome is visible on the scale of the blood pressure monitor when measuring blood pressure, this syndrome can not be diagnosed during a routine visit to the doctor. As practice shows, for the diagnosis and treatment of hypertension, one-time measurements of blood pressure in the doctor's office are too often erroneous.

The syndrome can detect instrumental diagnostics - an automated measurement of blood pressure for 15-20 minutes in the conditions of the clinics. Or 24-hour outpatient monitoring of blood pressure (AMAD), which is a diagnostic test of choice.

Thus, the diagnosis of the white coat syndrome with the help of outpatient monitoring of blood pressure, as well as its use as a confirmatory test in the examination of patients with suspected hypertension, according to experts from the British National Institute of Health, is the most accurate and cost-effective option for clinical diagnosis.

Differential diagnosis

Increasingly, for these purposes, a 24-hour BP measurement is used using various portable electronic devices. Thus, the purposeful control of the level of pressure in the ordinary household environment - more convenient and less expensive - provides differential diagnosis of the syndrome of white lab coat from chronic hypertension.

Treatment of the white coat syndrome

To date, the diagnosis and treatment of the white coat syndrome causes a lot of controversy in the medical environment, as there is still no convincing evidence that a temporary increase in blood pressure during a doctor's visit has a negative impact on health.

It is generally accepted that this syndrome does not need any treatment, that is, it is better to avoid unnecessary pharmaceuticals to reduce pressure, because their use can lead to vascular hypotension.

Prevention

Prevention of the possible development of hypertension does not hurt. First of all, these are changes in the way of life: getting rid of excess weight, systematic exercise, refusal to drink alcohol and smoking, diet with restriction of salt and sodium - see Diet under increased pressure

Forecast

The forecast for the development of negative consequences, which the white coat syndrome can lead, physicians associate with the state of the central nervous system, endocrine and cardiovascular system, kidneys, and the presence of genetic factors that lead to various violations of vasoconstriction and vasodilation.

Last update: 01.06.2018
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Medical expert editor

Portnov Alexey Alexandrovich

Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"

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