Even so-called ‘white coat hypertension’ – blood pressure measures that are only high in doctors’ offices – indicate that patients are at-risk for heart disease, heart attacks and even death, a new study suggests.
Some one-in-five Americans are estimated to have white coat hypertension.
But the condition is often left untreated, as doctors doubt that these read-outs suggest anything more than nervousness.
According to a new University of Pennsylvania study, white coat hypertension is very much a cause for concern, leaving patients at twice the risk of dying from heart disease that those with normal in-office blood pressure readings are.
About one-in-five Americans has ‘white coat hypertension,’ meaning their blood pressure soars when they’re in a doctor’s office. A new study suggests even this isolated incidence of hypertension predicts a two-fold greater risk of dying of heart disease (file)
Heart disease has long reined the number one killer of Americans – and it still does.
One of the key indicators that someone might be at risk for the life-threatening, chronic condition is their blood pressure.
As blood vessels become clogged and more narrow, the heart has to pump harder to move blood throughout the body.
Overworked hearts are more liable become distressed and diseased, and begin to fail.
Anyone with an systolic – or top – pressure between 130 and 139 is considered to have high blood pressure, since the American Heart Association recently altered its guidelines to make ‘high’ blood pressure lower.
A diastolic (bottom) pressure of 80 to 89 is considered high blood pressure.
About one third of Americans now fall into the worrisome ‘high blood pressure category.’
Those who only seem to have high blood pressure when they are in their doctors’ offices fall into a bit of a gray area.
Previous studies have suggested that as long as their high blood pressure is isolated to a clinical setting, most people are probably not at-risk.
The new University of Pennsylvania study suggests otherwise.
The researchers there analyzed data from 27 prior studies involving over 60,000 patients.
In order to define white coat hypertension across multiple studies with slightly different methodologies, the researchers made a distinction between those with ‘white coat hypertension’ and others with ‘white coat effect.’
Patients that had been classified as having white coat hypertension had high in-office measurements of blood pressure and high out-of-office blood pressures, which they took themselves at home, but were not being treated for the condition.
Those with white coat effect were classified as having high blood pressures at a doctor’s office, normal pressure at home, but who were not being treated for hypertension.
People who were struck by white coat hypertension were 36 percent more at-risk of developing heart disease.
They were also at a one-third greater risk of dying by any cause, and a 109 percent greater risk of dying from heart disease than were those with normal blood pressure or those who were treated for hypertension, but still got pressure spikes at the sight of a white coat.
Disparities that staggering suggest that many patients are slipping through the cracks on the assumption that their high in-office blood pressure is not the result of a health condition but of nerves.
The American Heart Association’s most recent guidelines recommend that people who have high blood pressure while at their doctor’s office should be monitored at home using wearable, 24-hour monitors or should take their own blood pressure at home.
‘Despite guideline recommendations, real-world practice has been slow to adopt out-of-office blood pressure monitoring,’ the study authors wrote.
‘The clinical inertia surrounding out-of-office BP monitoring seems to be driven by…skepticism over the utility of screening for isolated office hypertension.’
Lead study author Dr Jordana Cohen, an epidemiology and hypertension researcher at the University of Pennsylvania told Dailymail.com that it’s time that changed.
‘We think people should do more at-home monitoring, but right now it’s very narrowly covered by insurance,’ she said.
She’s hopeful that insurers will start covering ambulatory monitors – which are worn for 24 hours for a day – and at-home monitors more broadly.
The idea is to catch patients before they transition from having intermittent high blood pressure to having consistently high blood pressure that can become life-threatening.