Years ago I explained how a spike in blood pressure at the sight of a doctor’s “white coat” could be sign of poorly controlled blood pressure, putting one at risk of stroke, retinopathy, heart disease and kidney damage, but the medical consensus, at the time, felt it was “benign.” My argument was if a white coat makes one’s blood pressure spike, so could a G-string, bank hold up, or call from a mother-in-law, suggesting one’s blood pressure may be spiking throughout the day. Catching this spike during a routine doctor’s visit could be lifesaving. Now a study agrees that “White Coat Hypertension (‘WCH)” can put one at higher risk of heart disease and should NOT be ignored.
Researchers in the Annals of Internal Medicine found untreated WCH put one at increased risk for cardiovascular death.
…untreated WCH was associated with an increased risk for cardiovascular events (hazard ratio [HR], 1.36 [95% CI, 1.03 to 2.00]), all-cause mortality (HR, 1.33 [CI, 1.07 to 1.67]), and cardiovascular mortality (HR, 2.09 [CI, 1.23 to 4.48]); the risk of WCH was attenuated in studies that included stroke in the definition of cardiovascular events (HR, 1.26 [CI, 1.00 to 1.54]). No significant association was found between treated WCE and cardiovascular events (HR, 1.12 [CI, 0.91 to 1.39]), all-cause mortality (HR, 1.11 [CI, 0.89 to 1.46]), or cardiovascular mortality (HR, 1.04 [CI, 0.65 to 1.66]). The findings persisted across several sensitivity analyses.
They recommend, therefore, “out of office” blood pressure monitoring if WCH is suspected, as do I.
Last year a study found that WCH affects at least 30% of Americans, could signify significant disease.
“White Coat Hypertension” is believed to be a temporary spike in which blood pressure will rise either systolically (the pumping pressure) or diastolically (the filling pressure) or both. Damage to brain tissue, heart, eyes, kidneys and other organs can occur during these spikes.
Study author, Dr. Raymond Townsend, director of the hypertension program at Penn Medicine, states, “We encourage our patients to do blood pressure readings at home. That is a good way to not only monitor blood pressure where you actually “live”, but it also provides a lot of insight for patients to understand how life’s little indiscretions, like take-out Chinese with extra soy sauce, can truly affect your blood pressure the next day,” reported in a piece by NBC News.
24 hour monitoring can be done at home or at work where one monitors their blood pressure throughout the day and night, allowing the medical provider to identify spikes that may be missed during a 15 minute office visit.
New Blood Pressure Guidelines Introduced Last Fall
High blood pressure has now been redefined as being greater than 130/80 mmHg, down from 140/90 mmHg. This will mean close to 103 million more Americans will fall under the “hypertensive” category.
Multiple agencies, including the American Heart Association and American College of Cardiology, redefined the guidelines, in practice for the last 14 years, to lower the threshold for high blood pressure from 140/90 to 130/80.
Under the old guidelines, 1/3 of US Americans were considered to have high blood pressure. Now 42% of Americans will be “hypertensive”.
In lowering the guidelines, task force members hope to reduce complications associated with high blood pressure and start treatment earlier in those who have not been treated.
What do the blood pressure numbers mean?
The top number, or systolic pressure, is the pressure the heart exudes during a beat or pumping of the blood.
Diastolic pressure is the pressure in your arteries between beats while the heart is “filling”.
Both numbers are equally important as elevation of either can increase one’s risk of cardiovascular disease.
What can long term high blood pressure do?
Chronic high blood pressure can be dangerous. It may cause:
- Heart attacks
- Heart failure
- Kidney disease
- Eye damage – vision loss
- Erectile dysfunction…to name a few.
How do we treat high blood pressure?
The stages of blood pressure are defined in the chart above. At the elevated or early stages of high blood pressure the following lifestyle changes will be recommended:
- Weight loss
- Low salt diet
- Low fat diet
- Good sleep habits
- Regular exercise
- Avoiding tobacco products
- Limiting alcohol consumption
As a family physician I would also screen for diabetes, high cholesterol, low thyroid, kidney disease and sleep apnea.
If blood pressure cannot be controlled and continues to rise, medications may be prescribed to decrease blood volume, or lower the heart rate, or relax the blood vessels.