Background: The white coat effect is observed in many patients with hypertension, but its mechanism is still unclear and anxiety is often thought to be a key point. Methods: A total of 544 patients who met the inclusion criteria were recruited through outpatient clinics. Three months after systematic treatment, the office blood pressure and ambulatory blood pressure monitoring (ABPM) were examined. Patients who reached the ABPM standard were divided into white coat effect (n = 112) and control (n = 432) groups according to the results of the office blood pressure. The degree of anxiety in the two groups was evaluated using the Self-rating Anxiety Scale (SAS) and the Beck Anxiety Scale (BAI). Differences in anxiety, gender, age, number of antihypertensive drugs, cost per tablet and marital status were analyzed. Results: There was no significant difference in the degree of anxiety between the white coat and control groups, with mean SAS standard scores of 32.8 \pm 8.5 vs. 31.8 \pm 9.9, respectively (p = 0.170). Similarly, the mean BAI standard scores were 31.4 \pm 8.3 vs. 31.2 \pm 9.5, respectively (p = 0.119). Logistic regression analysis showed that the factors of female gender (\beta = –1.230, p 0.001), old age (\beta = 0.216, p 0.001), number of antihypertensive drugs (\beta = 1.957, p 0.001), and cost per tablet (\beta = 1.340, p 0.001) were significantly related to the white coat effect. Conclusions: Anxiety was not necessary for the white coat effect in hypertension patients during treatment. Female gender, old age, number of antihypertensive drugs used and cost per tablet were related to the white coat effect in hypertension patients during treatment.