Patients with “white coat hypertension” may be twice as likely to die of heart disease


Patients with “white coat hypertension” may be twice as likely to die of heart disease

If you avoid going to the doctor’s office because your blood pressure is always high, a new study finds you may be more likely to die of heart disease. The phenomenon is referred to as “white coat hypertension” (because of doctor’s traditional white coats) and is defined when a person’s blood pressure is normal at home but is high when at the doctor’s office.

A meta-analysis published in the journal Annals of Internal Medicine found patients with this condition who do not take hypertension mediation are twice as likely to die of heart disease as patients with normal blood pressure readings. The odds of having a heart attack or stroke were also about one-third higher for those with white coat hypertension.  Their risk of dying prematurely from any cause was also increased by about a third compared to people with no blood pressure problems.
What is blood pressure?

Blood pressure is a measure of the force at which blood flows through our veins, arteries, and capillaries.  When the force is too great, it is called hypertension or high blood pressure.  High blood pressure is considered anything above 130/90. The first number (130) is the systolic pressure and reflects the pressure in vessels when the heart beats. The second number (90) is the diastolic pressure and is a measure of when the heart is at rest or between beats.

Understanding white coat hypertension and results of the study

It is not known what specifically causes white coat hypertension but it likely has different triggers in different patients. For some, anxiety may cause their blood pressure to rise in medical settings but for others, it may be due to fluctuating blood pressure due to an underlying physiological condition.

It is important for everyone to know their blood pressure as this reading is a vital indicator of possible heart disease. People with white coat hypertension may be monitored properly and may feel if they don’t know what their blood pressure is, then everything must be fine.

About 1 in 5 American adults may have white coat hypertension, is what research suggests. For this recent study and to understand the health risk of white coat hypertension, researchers reviewed 27 studies involving more than 64,000 people in the U.S., Europe, and Asia. When compared with people with normal blood pressure readings both at home and in the doctor’s office, people with white coat hypertension were at elevated risk for cardiovascular events and death.

Specifically, what was found in the review was patients with white coat hypertension had a 36% increased risk for heart disease, 33% increased risk of death due to any cause and 109% increased risk of death from heart disease. Also found however, was patients who experienced high blood pressure readings at the doctor’s office but normal at home, but were also taking their blood pressure medications, had no increased risk of cardiovascular events or mortality.

One factor noted in the study is to determine if a patient who appears to have white coat hypertension may also have sustained high blood pressure even at home.  Anyone having sustained high blood pressure is a real concern. It was also noted that people with white coat hypertension who had the biggest risk to their health were those who also had other risk factors such as prior heart disease or chronic kidney disease along with older age. 

What this study shows is it’s important to monitor blood pressure in more than one setting. It’s also important to make sure blood pressure is being taken properly to get the most accurate reading.

To get more accurate and consistent blood pressure readings from a home blood pressure monitor follow these tips:

·      Be consistent by using the same arm each time and at the same time of day.

·      It is advised to take your blood pressure between 5 a.m. and 9 a.m. and before taking any blood pressure medication.  Blood pressure is usually at its highest during these times but if it is well-controlled during then, it will likely be well-controlled at other times of the day.

 ·      Take your blood pressure before eating or using caffeine, alcohol or exercise and wait at least 30 minutes after doing so.  Rest quietly at least 5 minutes before take measurements. 

·      Use the bathroom before taking a blood pressure reading as a full bladder can slightly increase it.

·      When taking blood pressure, sit correctly.  Sit with your back straight and supported (on a dining chair rather than a sofa).  Your feet should be flat on the floor and your legs should not be crossed.  Stretch your arm with palm upward supported on a flat surface (such as a table) with the upper arm at heart level.  Make sure the bottom of the cuff is placed directly above the bend of the elbow.  

·      Place the cuff on your bare arm – do not roll up a sleeve that might constrict your upper arm. 

·      Before taking a reading, calm yourself for 3-5 minutes.  After taking a reading, rest quietly for one minute and take a second reading.  The first reading will often be higher than the second reading. 

If a high blood pressure is recorded, it is important to measure two additional times, waiting a few minutes between measurements.

Blood pressure of 120/80 or above is considered elevated; 130/80 to 139/89 is considered Stage 1 hypertension and anything 140/90 or above is considered stage 2 hypertension, according to the American Heart Association and American College of Cardiology guidelines.

If blood pressure reaches 180/120 or higher – and either number in the blood pressure reading counts – people will be classified as in hypertensive crisis with need for immediate treatment or hospitalization.  

Blood pressure varies throughout the day, and readings are often a little higher in the morning. Also, your blood pressure might be slightly lower at home than in a medical office, typically by about five points.

Contact your doctor if you have any unusual or persistent increases in your blood pressure. Ask your doctor what reading should prompt an immediate call to the medical office.