Mental Arithmetic Is a Useful Diagnostic Evaluation in White Coat Hypertension

It remains unclear whether patients with white coat hypertension are more susceptible to mental stress than are those with essential hypertension. To compare the pressor responses to mental arithmetic between the two types of hypertension, 21 untreated female outpatients, aged 42 to 64 (mean 55) years, with hypertension, were studied. After 2 weeks of self-monitoring blood pressure, 11 patients were diagnosed as having white coat hypertension and the remaining 10 patients were diagnosed as having essential hypertension. The systolic and diastolic blood pressure responses to mental arithmetic testing were significantly greater in the patients with white coat hypertension (+38 ± 18/+24 ± 13 mm Hg) than in those with essential hypertension (+21 ± 8/+13 ± 6 mm Hg). These differences also were statistically significant in controlling for the effects of age and baseline blood pressures. These data suggest that mental arithmetic testing may be a useful tool for the diagnosis of white coat hypertension.