Does resting heart rate measured by the physician reflect the patient’s true resting heart rate? White-coat heart rate

Abstract

Objectives: In cardiology, resting heart rate (HR) and blood pressure (BP) are key elements and are used to adapt treatment. However HR measured in consultation may not reflect true resting HR. We hypothesize that there may be a “white-coat” effect like with BP and that there may be an association between HR variations and BP variations. Methods: This prospective, monocentric, observational, pilot study (January-April 2016) included 57 consecutive ambulatory patients at Poitiers University Hospital, France (58% male, mean age 64 years). Patients’ resting HR and BP were recorded with the same automated blood pressure sphygmomanometer in consultation by the physician then with self-measurement at home. Results: In the overall cohort, we found that HR was significantly higher in consultation (70.5bpm ± 12.6 vs. 68.1bpm ± 10.1, p = 0.034). HR also correlated with diastolic BP (r = 0.45, p = 0.001). Patients were divided into three groups to look for associations with BP: masked HR, (higher HR at home, 38.6%), white-coat HR, (lower HR at home 52.6%) and iso HR, (no change between HR at home and consultation, 8.8%). Although there was no difference between groups in diastolic BP measured in consultation, home diastolic BP was lower in the white-coat HR group (74.3 mmHg ± 9.8 vs. 77.9 mmHg ± 7.5, p = 0.016). Conclusions: Our study brings to light an exciting idea that could have a major therapeutic and maybe prognostic impact in cardiology: resting HR measured by the physician in consultation does not reflect true resting HR. This must be taken into account to adapt treatment.

Keywords

• Blood pressure
• Heart rate
• Self-measurement
• White coat syndrome