White coat hypertension spikes during COVID-19 state of emergency

Declaring a state of emergency to curb the spread of the coronavirus disease 2019 (COVID-19) correlates with an increase in white coat hypertension, reports a recent Japan study.

The retrospective study included 748 patients (mean age 67.3 years, 57 percent men) with chronic diseases who had available blood pressure (BP) measurements during and before the state of emergency in Japan from 7 April to 31 May 2020. BP was measured both in the doctor’s clinic (office BP) and at home (home BP). White coat hypertension was defined as having office BP ≥130/80 mm Hg and home BP <125/75 mm Hg.

Office systolic (SBP; p<0.001) and diastolic (DBP; p=0.03) BP were significantly elevated during the state of emergency as compared with measurements collected in March 2020 before the official decree was made.

In contrast, home SBP (p<0.001) and DBP (p=0.01) were significantly lowered during the state of emergency relative to a few months prior. Moreover, the percentage of participants who achieved the target home BP increased significantly during the state of emergency (p<0.001).  

In turn, the prevalence of white coat hypertension increased significantly from 13 percent during January to March 2020 to 17 percent during the state of emergency (p<0.001). No such effect was reported for masked or sustained hypertension.

“To prevent cardiovascular events, general practitioners should pay careful attention to BP management and may need other strategies for BP management that differ from those in usual daily clinical practice during the COVID-19 pandemic,” the researchers said.