A recent Medscape article talks about White Coat Hypertension, the phenomenon where your BP shoots up in the doctor’s office and is not truly reflective of your average blood pressure. The Medscape article mentions a recent Italian study – the PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) Study – impressively followed up 3200 patients and gathered 16 years of cardiovascular data. What they found was that about 40% of the people who had high readings in the office had white coat hypertension. What that means is that the BP readings in the clinic were high but the home readings or ambulatory monitor readings were not. The study also detailed more findings:
What they found is that true white coat hypertensives — that is, people [whose blood pressure was] really elevated in the office, more than 140 and more than 90, or more than 90 — had almost no increase in risk, at least during the first 6-8 years. Those who had partial white coat hypertension, where one of the other readings was above those numbers, tended to have a much greater risk than the so-called true white coat hypertensives but still less than the normal tensives. The other thing that’s very important, too, is that partial white coat hypertensives were much more likely to develop hypertension than true white coat hypertensives, but both of them were elevated relative to people who were normal-tensive on all 3 measurements.
The looked at a variety of different ways, and office blood pressure, in some cases, was, in fact, predictive. Home diastolic blood pressure was predictive. It’s a very extensive paper. It teaches us right now that they’re really going to use blood pressure measurements to assess prognosis and to assess outcomes. We can’t just rely on office, or home, or ambulatory. We probably need all 3 of them. I think this should, and eventually will, revolutionize how we measure blood pressure.
Home blood pressure machines of the digital type are getting more accurate and affordable. Get these calibrated (or checked against the office BP set) with your doctor just to be sure of their accuracy and make full use of these. We have found the arm cuff devices are still better and more accurate than the wrist cuff ones.
We repeat a piece of advice we posted a few years back on How to Check your Blood Pressure at Home
Take the BP at the same regular hour every day as a routine. Sit down for 5 mins, try to relax before inflating the machine. Take it three times a day, say morning after wash-up, evening when you return after work and at night before bedtime. That day’s BP will then be the average of the three recordings. Keep a record book. You will find that the morning readings will be the highest ( morning surge ) as our BP through-out the day also have a certain circadian cycle. We like all average readings to be 130/80mmHg or less.
Any reading between 130/80 – 140/90 mmHg should make you aware that you need life-style modification ( mainly, no added salt in food, alot of green veges and fruits, lose weight and have regular exercise ). Any reading consistently beyond 140/90 mmHg, should be brought to the attention of your family doctor.
Prevention is better then cure. Hypertension is a chronic lifestyle disease and the management must begin with life style modification.
Just to leave with a joke. A relative of mine once quipped “High blood pressure? I don’t have high blood pressure. I give high blood pressure!”