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The Potential Cardiovascular Consequences of White-Coat Hypertension Explored

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The Stress of Doctor Visits and Its Impact on Blood Pressure

For many individuals, a visit to the doctor can be an anxiety-inducing experience. In some cases, this stress can cause a temporary increase in blood pressure. If this phenomenon occurs only during medical appointments and your blood pressure remains normal at home and in other nonmedical settings, you may be dealing with a condition known as white-coat hypertension. Recent findings from a large study have shed light on the potential risks faced by individuals with this condition, indicating a greater threat of heart disease compared to those who consistently maintain normal blood pressure readings.

Understanding Blood Pressure Levels and Guidelines

According to guidelines set by the American College of Cardiology and the American Heart Association, blood pressure values below 120/80 are considered normal, while readings of 130/80 and higher indicate high blood pressure. Dr. Randall Zusman, a cardiologist from Harvard-affiliated Massachusetts General Hospital, highlights the importance of recognizing the implications of blood pressure elevation in non-threatening situations, such as during a doctor's visit. If blood pressure spikes under these conditions, one may question how the body would respond in more stressful situations like being involved in a road incident or facing challenging circumstances at home or work.

Beyond Normal Fluctuations: The Impact of White-Coat Hypertension

Analyzing data from 27 studies involving over 64,000 participants from various regions, including the United States, Europe, and Asia, researchers have unveiled the potential risks associated with untreated white-coat hypertension. Compared to individuals with consistently normal blood pressure readings at the doctor's office and at home, those with white-coat hypertension experienced a 36% higher risk of heart attack, stroke, and other heart-related events. Additionally, they were twice as likely to die from heart disease. Notably, individuals taking blood pressure medication who still exhibited elevated readings during medical appointments did not demonstrate an increased risk of heart disease.

The Importance of Addressing White-Coat Hypertension

Dr. Zusman emphasizes the significance of treating individuals with white-coat hypertension, as research suggests that this condition tends to progress to sustained high blood pressure. Treatment, however, does not necessarily entail medication. Lifestyle modifications, such as weight loss, regular exercise, salt restriction, and avoiding smoking, have been linked to improved blood pressure control. Dr. Zusman reinforces the importance of adopting these changes for individuals with intermittent or sustained high blood pressure.

In cases where lifestyle modifications alone prove insufficient, a variety of safe and effective medications can be employed as part of the treatment plan. Dr. Zusman advises his patients to utilize a home blood pressure monitor to monitor their progress. He also ensures that they understand how to correctly use the device by having them demonstrate their blood pressure measurement technique during their appointments. Healthcare professionals often recommend frequent blood pressure monitoring during the initial stages of medication initiation or adjustment, followed by regular checks two to three times a week at various times throughout the day.

Empowering Individuals to Take Control of Their Blood Pressure

By recognizing the potential risks associated with white-coat hypertension and understanding the importance of accurate blood pressure measurement, individuals can take proactive steps to manage their condition effectively. Implementing lifestyle changes and actively monitoring blood pressure can play a vital role in reducing the risks of heart disease and improving overall cardiovascular health.

William H. McDaniel, MD

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School.

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