Many thanks for your comments about our recent article.1 We are happy to give a definition of ‘white-coat’ effect. This phenomenon refers to the transient rise in blood pressure triggered by a visit to the doctor’s office, caused by an alerting reaction. The difference between blood pressure measured in the clinic and on ambulatory blood pressure monitoring is usually defined as ‘white-coat’ effect whereas the clinical situation in which persistently high office blood pressure and normal ambulatory blood pressure coexist regardless of the degree of ‘white-coat’ effect is referred to as ‘white-coat’ hypertension.2,3 We agree that it would be interesting to look at the effects of medication on our findings but our study was not set up to do this. Patients on medication referred to our service are complex and usually on multiple medications. It would be impossible to identify differences from individual medication for this reason. We believe such a study would have to be done prospectively. We can confirm that detailed instructions are given to patients when they wear ambulatory monitoring and a patient diary is recorded. We agree that further analysis of the effects of comorbidity on the findings would be interesting to do. We are not able to confirm that the first blood pressure was always the highest as this was not recorded, but data collected since this study suggests that this is often the case. Finally, thank you for pointing out that the ‘no-difference’ line is above zero on Figure 2; we believe this is a publishing error.
- © British Journal of General Practice 2013