January 16, 2019 by Laura Pincus and Patty Shillington
‘White Coat Hypertension’ Should Be Taken More Seriously, New Study Finds
Do you get nervous when your blood pressure is taken at the doctor’s office? If you do and your blood pressure surges above a normal level because of the anxiety, then you may suffer from a condition known as “white coat hypertension” or “white coat syndrome” — which may affect up to 30 percent of Americans.
The prevailing school of thought has been that white coat hypertension isn’t something to worry about. But that may not be the case. If seeing a white coat makes your blood pressure jump, then other stressors in everyday life may do the same. And that may require a diagnosis of hypertension, or high blood pressure, which may necessitate medication or lifestyle changes, or a combination of both.
A new study published in the New England Journal of Medicine suggests that white coat hypertension, or “masked hypertension” as the researchers call it, could pose a greater risk of death than “diagnosed and sustained hypertension.”
Researchers from the Autonomous University of Madrid, who followed 64,000 people over five years, concluded that blood pressure measurements taken at home regularly were a stronger predictor of cardiovascular deaths than doctor’s office readings. Researchers found that people who experienced the white coat effect had double the chances of dying, compared to patients whose blood pressure was normal when taken at the doctor’s office and at home.
Monitoring Your Blood Pressure Properly
Properly monitoring blood pressure with a home device for several days, under a doctor’s guidance, is the most recommended strategy for determining if someone with white coat syndrome is actually at risk. High blood pressure, determined by a sustained reading of 130/80 or higher, is a major risk factor for heart disease and stroke – the two leading causes of death in the world.
“For patients who have shown signs of elevated blood pressure, I tell them to keep a blood pressure log for about seven days,” says Juliet Vento, M.D., a primary care physician with Baptist Health Primary Care. “By looking at the numbers on their blood pressure log, it helps us guide our treatment.”
Before home monitoring begins, it’s crucial to consult with you primary care doctor to make sure you’re using the home-based devise properly. It’s important for people who self-monitor to calibrate their devices at their doctor’s office, says Harry Aldrich, M.D., head of the cardiovascular section of the Miami Cardiac & Vascular Institute at South Miami Hospital.
And most importantly, Dr. Aldrich adds, it’s critical they don’t reduce or increase blood pressure medication based on changes in their BP readings — without consulting their physicians. “You should never adjust your BP medication unless your doctor tells you to,” says Dr. Aldrich. “Self-regulating medication leads to sporadic BP control.”
In 2015, the U.S. Preventive Services Task Force, an independent panel of volunteer physicians that makes recommendations for preventive medicine, considered the white coat hypertension, leading to expanded guidelines. The update urged physicians to confirm a high blood pressure diagnosis with follow-up measurements before prescribing blood pressure medication or other medical interventions to a patient.
Repeated Measurements are More Accurate
“Because blood pressure is a continuous value with natural variations throughout the day, repeated measurements over time are generally more accurate in establishing a diagnosis of hypertension,” the task force said at the time.
Add to the importance of determining your true blood pressure are updated guidelines issued by the American Heart Association (AHA), the American College of Cardiology late last year.
Under the new standard, the redefined reading of high blood pressure is 130/80, down from 140/90. The stricter reading, the first major change in blood pressure guidelines in 14 years, means that 46 percent of U.S. adults, including an increasing number under the age of 45, now will be considered hypertensive. Under the previous guidelines, 32 percent of U.S. adults were considered hypertensive.
“This change will likely lead to earlier screening and management of cardiovascular risk factors in mid-life,” says Felipe De Los Rios, M.D., Medical Director, Stroke Program at Baptist Health Neuroscience Center. “This is what is needed to really decrease the risk of stroke and heart attack as we age. Hopefully, this change will also bring early management of the other risk factors, such as high cholesterol, diabetes, obesity, tobacco use, and sedentarism.”
According to the American Heart Association, these are the proper steps to follow when measuring your blood pressure at home:
- Choose a monitor that has been validated and it is automatic, bicep (upper-arm) and cuff-style.
- Do not drink any beverages containing caffeine, do not smoke or exercise within 30 minutes before you measure your blood pressure.
- Be still; sit with your back straight and your feet flat on the floor.
- Measure at the same time every day, such as morning and evening.
- Take a couple of readings one minute apart and record the results.