White coat hypertension, the condition where a patient’s blood pressure readings are higher when taken at a doctor’s office compared to other settings, has now been linked to an increase in heart disease. The condition has long been recognized as more of an imposition, but this new study goes to show just how dangerous it can be if left untreated.
White coat hypertension was originally attributed to the anxiety that patients might experience during medical appointments. However, over the last few years, research has shown that the elevated readings might actually be a sign of underlying risk for future health problems.
High blood pressure is a common condition that affects almost one-third of American adults. The danger of the long-term force of blood against artery walls could be high enough that it may eventually cause cardiovascular risks, such as heart disease and stroke.
To help diagnose and manage those with the condition, recent hypertension guidelines have been put into place. Those guidelines include a strong recommendation of out-of-office blood pressure monitoring such as at home and ambulatory monitoring, which requires patients to wear a portable device that records blood pressure readings over a 24-hour period. The problem is that many practitioners have been reluctant to adopt this practice due to skepticism over inconsistent findings from past research and its uncertainty around the connections with heart disease and death.
The study led by researchers from Penn Medicine and published in the Annals of Internal Medicine showed a connection between untreated white coat hypertension and a heightened risk of heart disease. They also found that patients who exhibited white coat hypertension were twice as likely to die from heart disease than those with normal blood pressure.
Also noted was that patients with white coat hypertension who were treating high blood pressure with medication did not show an increased risk of cardiovascular-related death or heart disease compared to those with normal blood pressure readings.
Risk of Heart Disease and Death
For the study, the researchers analyzed 27 various studies including more than 60,000 patients. They found that with those who presented symptoms of white coat hypertension, there was a 36 percent increased risk of heart disease, 33 percent increased risk of death, and 109 percent increased risk of death from heart disease.
The study’s lead author Jordana B. Cohen spoke about the research. “Our findings support the pressing need to increase out-of-office blood pressure monitoring nationwide, as it’s critical in the diagnosis and management of hypertension. Simultaneously, we advise individuals with untreated white coat hypertension to engage in lifestyle modifications, including smoking cessation, reduction in their alcohol intake, and making improvements to their diet and exercise regimens. We also caution providers not to over-treat individuals with white coat hypertension who are already on blood pressure medication, as this could lead to dangerously low blood pressure outside of the office and unnecessary side effects from medication.”
“Know what your blood pressure is, and what your goal is. Learn how to take blood pressure so you get a quality blood pressure reading. I think everyone should have a home monitor, even if their health care provider doesn’t specifically recommend it,” she said.
Ask your doctor for a blood pressure reading at least every two years starting at age 18. If you’re age 40 or older, or you’re 18 to 39 with a high risk of high blood pressure, ask your doctor for a blood pressure reading every year. And don’t be afraid to check it yourself at home to make sure you are receiving an accurate reading and not suffering from white coat hypertension.
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