White-coat hypertension: management and adherence to guidelines by European and Canadian GPs. A cross-sectional clinical vignette study

• Main Authors: Xavier Humbert, Sophie Fedrizzi, Emmanuel Touzé, Joachim Alexandre, Paolo-Emilio Puddu
• Format: Article
• Language: English
• Published: Royal College of General Practitioners 2019-10-01
• Series: BJGP Open
• Subjects: white-coat effect; white coat hypertension; hypertension; blood pressure monitoring, ambulatory; guidelines; general practice; primary health care
• Online Access: https://bjgpopen.org/content/3/4/bjgpopen19X101664

Background: White-coat hypertension (WCH) is also referred to as 'isolated clinic hypertension'. While it is a frequently encountered phenomenon, WCH is not systematically evoked, and its management remains unclear due to the contradictory guidelines provided by professional societies. Aim: To examine WCH management by GPs in Europe and Canada. Design & setting: A clinical vignette of a possible case of WCH was created from the literature, and the responses of GPs to WCH-specific questions in a cross-sectional electronic questionnaire were compared. Method: Complete electronic questionnaire responses from Europe and Canada were systematically analysed. Results: Among 770 eligible questionnaires (useful response rate: 10.6%), 43.5% were from France, 19.2% from Belgium, 7.8% from England, 19.5% from Switzerland, and 10.0% from Canada. Based on the clinical information provided in the vignette, GPs overall diagnosed hypertension and WCH equally (50.7% versus 49.3%, respectively). Canadian GPs suggested hypertension more frequently than European GPs in general (64.2% versus 46.1%, P<10–4), and more frequently used ambulatory blood pressure monitoring ([ABPM] 42.3% versus 26.1%, P = 0.01). In both groups of GPs, WCH was managed similarly (no treatment, 100% versus 97.3%, P = 0.39). Generally, the GPs all followed WCH patients for 3–6 months (51.3% versus 66.2%, P = 0.1), and they were not aware of the WCH guidelines (47.3% versus 52.1%, P = 0.54). Conclusion: Although WCH guidelines are different, WCH management by GPs is very similar except for diagnosis. Homogeneity in WCH guidelines is required and should be systematically implemented in hypertension guidelines to avoid inappropriate management of the condition.