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The White Coat and Hypertension

One of the stressful things that the doctor does is take your blood pressure. As we feel that cuff inflate and put a little pressure on our arm, we wonder what the number will be, and whether the doctor will smile or frown at the results.

For many years, doctors and patients have recognized the “white coat hypertension” phenomenon, where a person’s blood pressure in the doctor’s office is much higher than expected, and often much higher than if the person has been checking the blood pressure at home.

What does “white coat hypertension” mean? Does it have the same implication as persistent hypertension that requires lifetime treatment, or is it a forerunner of persistent hypertension, and what effect does it have on cardiovascular events such as myocardial infarction (heart attack) or stroke?

Recent data from the Dallas Heart Study published in the American Journal of Cardiology looked at this issue again, and in addition looked another interesting phenomenon – “Masked Hypertension.” [1]This is when the person’s blood pressure is fine in the doctor’s office, but elevated at times at home when continuous or intermittent blood pressures are checked by the person themselves.

In a study of just over 3000 patients, of which 50% were African-American (very unusual in most hypertension studies), the prevalence of White Coat Hypertension was only 3.3% but that of Masked Hypertension was much higher, at 17.8%, or almost one out of five patients! Both White Coat Hypertension and Masked Hypertension were associated with stiffness of the aorta (not a good thing long term), early injury to kidneys, and “hard” cardiovascular events, such as angina, stroke, heart failure, atrial fibrillation, and the need for coronary artery bypass surgery or angioplasty.

The “take-home” message from this study is that to determine whether someone has high blood pressure that requires treatment may require more than the doctor’s office. Home monitoring of blood pressure, now easily available with accurate and low cost electronic devices, is likely a good investment in preventative medicine.

[1] Tiencheu D, Ayers C, et al. Target Organ Complications and Cardiovascular Events Associated with Masked Hypertension and White-Coat Hypertenison, American Journal of Cardiology 2015 66(20), p. 2159-2169.

Dr. Arnold Meshkov

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