Prevalence of white coat and coincidental hypertension among preoperative patients
DOI:
https://doi.org/10.18203/2320-6012.ijrms20263088Keywords:
Blood pressure, Coincidental hypertension, Preoperative assessment, White coat hypertensionAbstract
Background: Hypertension is a major global health concern with significant perioperative implications. White coat hypertension (WCH) and coincidental hypertension (CH) are undiagnosed blood pressure patterns that affect surgical outcomes, sometimes causing unnecessary interventions or delays. This study determined the prevalence of WCH and CH during preoperative assessment at the BMU and associated clinical factors.
Methods: This cross-sectional study was conducted at the department of anesthesia, analgesia and intensive care medicine, Bangladesh Medical University (BMU), Dhaka, Bangladesh, from April 2024 to March 2025 among 2,084 adults who underwent elective surgery at the preoperative assessment unit (PAU). Patients ≥18 years were purposively sampled, blood pressure was measured, and patients were classified as known hypertensive, normotensive, or undiagnosed. Undiagnosed cases were followed up to pre-induction and categorized as white coat or coincidental hypertension. Data were analyzed using SPSS version 27.0.
Results: Among the 2,084 preoperative patients, 445 (21.4%) were hypertensive, 1,561 (74.9%) were normotensive and 78 (3.7%) had previously undiagnosed hypertension, including 26 (33.3%) with white-coat hypertension and 52 (66.7%) with coincidental hypertension. Patients with coincidental hypertension were older, had more comorbidities, experienced more surgical cancellations (11.5% versus 0%; p=0.049), and had significantly higher systolic and diastolic blood pressure throughout the follow-up than those with white coat hypertension (all p<0.05).
Conclusions: Undiagnosed hypertension is common in the preoperative setting, with coincidental hypertension being more prevalent than white coat hypertension and associated with higher perioperative risk and surgical postponement.
References
World Health Organization. Global report on hypertension: the race against a silent killer. World Health Organization; 2023.
Gill R, Goldstein S. Evaluation and management of perioperative hypertension. In: StatPearls. StatPearls Publishing; 2023.
McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension: Developed by the task force on the management of elevated blood pressure and hypertension of the European Society of Cardiology (ESC) and endorsed by the European Society of Endocrinology (ESE) and the European Stroke Organisation (ESO). Eur Heart J. 2024;45(38):3912-4018.
Hartle A, McCormack T, Carlisle J, Anderson S, Pichel A, Beckett N, et al. The measurement of adult blood pressure and management of hypertension before elective surgery: Joint Guidelines from the Association of Anaesthetists of Great Britain and Ireland and the British Hypertension Society. Anesthesia. 2016 Mar;71(3):326-37.
Pioli MR, Ritter AM, de Faria AP, Modolo R. White coat syndrome and its variations: differences and clinical impact. Integrated blood pressure control. 2018:73-9.
Martin CA, McGrath BP. White‐coat hypertension. Clin Exp Pharmacol Physiol. 2014;41(1):22-9.
Cobos B, Haskard-Zolnierek K, Howard K. White coat hypertension: improving the patient-health care practitioner relationship. Psychol Res Behav Manag. 2015:133-41.
Elendu C, Amaechi DC, Elendu TC, Amaechi EC, Elendu ID. Dependable approaches to hypertension management: a review. Medicine. 2024;103(24):e38560.
Siegel WC, Blumenthal JA, Divine GW. Physiological, psychological, and behavioral factors and white coat hypertension. Hypertension. 1990;16(2):140-6.
Spruill TM, Pickering TG, Schwartz JE, Mostofsky E, Ogedegbe G, Clemow L, et al. The impact of perceived hypertension status on anxiety and the white coat effect. Ann Behav Med. 2007;34(1):1-9.
Pickering TG, Friedman R. The white coat effect: a neglected role for behavioral factors in hypertension. In: Stress, coping, and disease. Routledge. 2013:35-49.
Mancia G, Facchetti R, Bombelli M, Cuspidi C, Grassi G. White-coat hypertension: pathophysiological and clinical aspects: excellence award for hypertension research 2020. Hypertension. 2021;78(6):1677-88.
Anuli I, Jideuma E, Frank O, Chinonye O, Chiagozie N, Hope I, et al. The burden of undiagnosed hypertension and associated risk factors among adults in a rural community in Imo State, South-East Nigeria. Int J Clin Med. 2024;15(2):101-22.
Hossain A, Suhel SA, Chowdhury SR, Islam S, Akther N, Dhor NR, et al. Hypertension and undiagnosed hypertension among Bangladeshi adults: Identifying prevalence and associated factors using a nationwide survey. Front Public Health. 2022;10:1066449.
T O’Donnell F. Preoperative evaluation of the surgical patient. Missouri Med. 2016;113(3):196.
Mengistu K, Geleta D. Prevalence of preoperative hypertension and its intraoperative anesthetic management among patients undergoing elective surgery at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia. Int J Med Med Sci. 2019;11(2):11-9.
Misra S. Systemic hypertension and non-cardiac surgery. Indian J Anaesth. 2017;61(9):697-704.
Nuredini G, Saunders A, Rajkumar C, Okorie M. Current status of white coat hypertension: where are we? Ther Adv Cardiovasc Dis. 2020;14:1753944720931637.
Fayad A, Yang H. Is peri-operative isolated systolic hypertension (ISH) a cardiac risk factor? Curr Cardiol Rev. 2008;4(1):22-33.
Manios ED, Koroboki EA, Tsivgoulis GK, Spengos KM, Spiliopoulou IK, Brodie FG, et al. Factors influencing white-coat effect. Am J Hypertens. 2008;21(2):153-8.
Tait A, Howell SJ. Preoperative hypertension: perioperative implications and management. BJA Educ. 2021;21(11):426-32.
Zambouri A. Preoperative evaluation and preparation for anesthesia and surgery. Hippokratia. 2007;11(1):13.
Mohseni S, Behnam-Roudsari S, Tarbiat M, Shaker P, Shivaie S, Shafiee MA. Perioperative hypertension etiologies in patients undergoing noncardiac surgery in University Health Network Hospitals- Canada from 2015-2020. Integr Blood Pressure Control. 2022:23-32.
Lien SF, Bisognano JD. Perioperative hypertension: defining at-risk patients and their management. Curr Hypertens Rep. 2012;14(5):432-41.
Rismiati H, Lee HY. Perioperative management of hypertensive patients. Cardiovasc Prevent Pharmacother. 2021;3(3):54-63.
Conen D, Aeschbacher S, Thijs L, Li Y, Boggia J, Asayama K, et al. Age-specific differences between conventional and ambulatory daytime blood pressure values. Hypertension. 2014;64(5):1073-9.
Huang Y, Huang W, Mai W, Cai X, An D, Liu Z, et al. White-coat hypertension is a risk factor for cardiovascular diseases and total mortality. J Hypertens. 2017;35(4):677-88.
Nemcsik J, Takacs J, Kekk Z, Farsang C, Simon A, Pall D, et al. White-coat effect and masked hypertension in patients with high-normal office blood pressure: results of the Hungarian ABPM Registry. J Hypertens. 2024;42(11):1976-84.
Stergiou GS, Asayama K, Thijs L, Kollias A, Niiranen TJ, Hozawa A, et al. Prognosis of white-coat and masked hypertension: International Database of HOme blood pressure in relation to Cardiovascular Outcome. Hypertension. 2014;63(4):675-82.
Singh D. Perioperative concerns in patients with ‘white coat hypertension’. Anaesth Pain Intens Care. 2019.
Aronow WS. Masked hypertension. Ann Translat Med. 2017;5(23):456.
Jardim TV, Carneiro CD, Morais P, Roriz V, Mendonca KL, Nascente FM, et al. White-coat, masked and sustained hypertension detected by home blood pressure monitoring in adolescents: prevalence and associated factors. Blood Press. 2018;27(3):151-7.
Aronow WS. Management of hypertension in patients undergoing surgery. Ann Translat Med. 2017;5(10):227.
Kario K, Thijs L, Staessen JA. Blood pressure measurement and treatment decisions: masked and white-coat hypertension. Circul Res. 2019;124(7):990-1008.
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