Is White Coat Hypertension a Concern in Mohs Micrographic Surgery?

September 2012 | Volume 11 | Issue 9 | Original Article | 18 | Copyright © September 2012


Irene J. Vergilis-Kalner MD

Skin Cancer and Aesthetic Surgery Center, New York, NY Robert Wood Johnson University Hospital, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ

Abstract
Objective: To examine white coat hypertension (WCHTN) in patients presenting for Mohs micrographic surgery (MMS) to determine whether it should be a concern.
Methods:In this prospective study, blood pressure (BP) was recorded in 100 consecutive patients who presented for MMS consultation and a subsequent MMS procedure, and compared on both days. Statistical analysis was performed using the paired Student t test and the significance of the findings was determined based on the corresponding P values. Progression from normotensive to hypertensive state while the doctor was in the room was stratified based on the patient's age, gender, and histories of smoking, hypertension (HTN), diabetes, and hyperlipidemia; as well as whether the doctor was wearing a white lab coat over blue surgical scrubs (50 patients) or blue surgical scrubs alone (50 patients).
Results: BP increased from baseline when the doctor entered the room and then decreased towards baseline after five minutes of the doctor being present. Elevation in BP was more evident in younger people, males, and those with HTN and hyperlipidemia. BP was slightly higher on the day of the consultation than on the day of the procedure. A higher number of patients became hypertensive when the doctor wore a white lab coat over blue surgical scrubs vs blue surgical scrubs alone. However, these changes in BP did not prove to be statistically significant.
Conclusion: Brief periods of WCHTN were seen on both days. However, these elevations in BP were not statistically significant and decreased towards baseline after five minutes. There were no cases in which elevation in BP associated with WCHTN was sufficient to result in the need to postpone or cancel MMS.

J Drugs Dermatol. 2012;11(9):e18-e22.

INTRODUCTION

White coat hypertension (WCHTN) refers to a clinical phenomenon characterized by elevated blood pressure (BP) when patients are in the doctor's office, where systolic BP ≥140 mm Hg, diastolic BP ≥90 mm Hg, or both, even though these individuals have normal BP (systolic BP <135 mm Hg; diastolic BP <85 mm Hg) under other circumstances. 1-8 It has previously been reported that up to one quarter of patients are prone to exhibiting WCHTN.6,9 Another study has shown that the prevalence of WCHTN varies by age, with 33.3% being seen in the patient's second decade, 46.6% in the third, 50% in the fourth, 48.9% in the fifth, 36.9% in the sixth, 19.2% in the seventh, and 8.3% in the eighth.7 This data indicates that WCHTN is much more likely to be seen in patients in their 30s. The prevalence of WCHTN has also been reported to vary from 15% to more than 50% of all patients with mildly elevated office BP values.8 Furthermore, the white coat effect is not connected to the baseline BP level and can also be observed in patients with a history of HTN.10
This study investigated WCHTN in 100 consecutive patients who presented for Mohs micrographic surgery (MMS) at a single Mohs surgeon's practice. Patients were evaluated based on changes in BP from before the doctor entered the room to five minutes after the doctor entered the room both on the day of the MMS consultation and on the day of the MMS procedure. These findings were analyzed with respect to age, gender, history of smoking, and prior diagnoses of HTN, diabetes mellitus (DM), and hyperlipidemia. It was also evaluated whether the type of the surgical garb worn by the doctor—white lab coat over blue surgical scrubs vs blue surgical scrubs alone—significantly influenced the degree of WCHTN.

METHODS

Patient Selection

In this prospective study, BP measurements were evaluated in 100 consecutive patients who presented for MMS at a single Mohs surgeon's practice for the treatment of their skin cancers under local anesthesia. Informed consent was obtained, and the following data were collected for each of these patients: age, gender, history of smoking, and past medical histories of HTN, DM, and hyperlipidemia (including elevated levels of cholesterol and triglycerides).
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