An Updated Meta-analysis of White Coat Hypertension and Mortality
Dr. Jordana Cohen, MD, MSCE, Deputy Director and Associate Professor of Medicine and Epidemiology, co-authored a new meta-analysis with Alavi Hossain and Raymond R. Townsend to investigate the mortality risk of untreated white coat hypertension (WCH) and treated white coat effect (WCE). These conditions, which are present in up to 1 out of 3 people, refer to elevated blood pressure readings in clinical settings that are not sustained outside the doctor’s office.
Dr. Cohen’s earlier meta-analysis, Cardiovascular Events and Mortality in White Coat Hypertension: A Systematic Review and Meta-analysis, published in the Annals of Internal Medicine, suggested a modest increase in mortality risk with WCH. However, in this new analysis, WCH was not significantly associated with all-cause mortality (HR 1.08, 95% CI 0.91–1.36) or cardiovascular mortality (HR 1.06, 95% CI 0.68–4.83). That said, the findings were largely driven by one large, potentially biased study, meaning the true risk of WCH may still be slightly elevated, though it remains uncertain.
This uncertainty reinforces a key takeaway: out-of-office blood pressure monitoring is essential for accurately diagnosing and managing hypertension. Relying solely on office readings could result in missed opportunities to identify those truly at risk—or overtreatment in those who are not.