Prevalence of White Coat Hypertension Among Surgical Patients at a Tertiary Care Hospital: A Cross-Sectional Observational Study.

Background The prevalence of white coat hypertension (WCH) among surgical patients is a significant concern. WCH refers to a condition where individuals with normal blood pressure at home exhibit elevated readings when measured at a medical facility, affecting clinical decision-making processes. The aim is to determine the prevalence of WCH among patients undergoing elective surgery at a tertiary care hospital and to evaluate its association with demographic factors, surgical type, and perioperative waiting time. A cross-sectional design was employed, enrolling 150 patients. The findings reveal a significant prevalence of WCH, especially among female patients, with varying prevalence rates across different surgical procedures. These results underscore the importance of recognizing WCH to avoid unnecessary delays or cancellations of surgeries and to implement appropriate management strategies that can enhance patient outcomes. Methodology This cross-sectional study assesses the prevalence of WCH among surgical patients at a tertiary care hospital in Karachi, Pakistan. The study was carried out at the preoperative assessment clinic, Aga Khan University Hospital, Karachi, from April 1, 2024, to September 30, 2024. One hundred and fifty patients were enrolled. All patients aged 18 to 75 years, of either gender, scheduled to undergo elective surgery were included. Blood pressure was measured as a routine by the preoperative assessment clinic staff using a standard mercury sphygmomanometer using accurate cuff sizes. Patients were instructed to monitor their ambulatory blood pressure at home. They were asked to maintain a detailed blood pressure chart, recording the date, time, and blood pressure values. This chart was reviewed by the research team on the day of surgery and used for comparison with clinic readings to assess for WCH.  Results The prevalence of WCH was 41.3% (n=62). Female (n=43) patients comprised a greater proportion (70%) of the total WCH cases. Around 33.3% patients were only those who presented a previous history of hospital admission, while 66.7% were those having primary admission. The most prevalent WCH was found in tumor excision cases (53.6%), followed by the renal surgery group (45.2%), then neurosurgery cases (42.5%). It was observed that there was an increased blood pressure range of ambulant daytime systolic and diastolic values in WCH cases in comparison to nighttime values. There was a significantly higher number of cases that had to wait longer before surgery in the preoperative holding area (p=0.002).  Conclusion The prevalence of WCH is significant among surgical patients. Early diagnosis and prompt management could reduce complications and the cancellation rate as well. All these findings emphasized the need to differentiate between essential hypertension and WCH, and once it is identified, it should be treated for a better outcome and to avoid case cancellation. Additionally, WCH has been associated with a greater risk of cardiovascular mortality compared to prehypertension. Recommendations support the use of non-pharmacological interventions for mild to moderate white coat hypertension (WCH), while pharmacological treatment may be considered in more severe cases. This approach differs from the management of essential hypertension.