Thursday , October 21 2021

Patients with untreated white coat hypertension twice as likely to die from heart disease



New research further clarifies the health risks of what is a common occurrence.

Doctor taking blood pressure

Patients with untreated white coat hypertension had a 36% increase in the risk of heart disease and a 33% increase in the risk of death compared to normotensive patients.

It is a very common scenario.

You take the patient's blood pressure and it is high.

"I always have high blood pressure when I'm at the doctor," the patient says.

You give them time to rest before doing another reading.

Patients whose blood pressure was raised in a doctor's office had been considered to have "white coat" syndrome in response to issues such as anxiety. These readings are not necessarily indicative of usual readings of a patient's blood pressure, or of risks subsequent to their health.

However, growing research bodies continue to point to the more ominous effects of white coat hypertension.

A new systematic review and meta-analysis, published in Annals of Internal Medicine, found that patients with untreated white coat hypertension not only have a high risk of heart disease but are twice as likely to die of heart disease compared to those with normal blood pressure.

Meanwhile, patients with white-coat hypertension who were taking antihypertensives had no increased risk of heart disease or death related to the cardiovascular system compared to those with normal blood pressure readings.

Studies suggest that about one in five adults may have white-coat hypertension. Our findings underscore the importance of identifying people with this condition, "said lead author Jordana Cohen, assistant professor in the Division of Electrolyte Renal-Electrolyte and Hypertension and a senior researcher at the Center for Clinical Epidemiology and Biostatistics.

"We believe that individuals with isolated hypertension in the office – those who are not taking blood pressure medication – should be monitored closely for the transition to sustained hypertension or elevated blood pressure at home and at the doctor's office."

For this study, the researchers performed a meta-analysis of 27 studies, comprising more than 60,000 patients with untreated white coat hypertension or treated white coat effect.

Compared to normotensive patients, those with untreated white coat hypertension had a 36% increase in the risk of heart disease, a 33% increase in the risk of death, and a 109% increase in the risk of death from heart disease.

"Our findings support the pressing need to increase out-of-office blood pressure monitoring across the country as it is critical in the diagnosis and management of hypertension," said assistant professor Cohen.

"At the same time, we advise individuals with untreated white coat hypertension to engage in lifestyle changes, including cessation of smoking, reduced alcohol consumption, and improvements in their diet and exercise.

"We also caution providers not to over-treat individuals with white coat hypertension who already take high blood pressure medications as this could lead to dangerously low blood pressures outside the office and unnecessary side effects of medication."

Finding the right balance between correctly identifying hypertension, not over-diagnosing or over-diagnosing, or sub-treating or over-treating can be challenging.

This is not the first article to point out the potentially harmful effects of white lab coat syndrome.

An article published last year in Korean newspaper concluded that white-coat hypertension is not "clinically innocent" because of its frequent association with metabolic abnormalities, subclinical organ damage, and a greater risk of cardiovascular events than in truly normotensive individuals.

'At present, the identification of the high-risk [white coat hypertension] the participants appear to be a key step in the selection of appropriate therapeutic strategies, including antihypertensive therapy, "the authors said.

"Ambulatory monitoring may be the most effective method to diagnose and confirm whether patients are persistently hypertensive or have white-coat syndrome."

This document went on to say that outpatient monitoring should be used to confirm the diagnosis of white coat hypertension within three months and every six months, as well as to provide continuous monitoring of these patients as there is a risk of developing true hypertension. .

This is linked to the RACGP Guidelines for preventive activities in general practice Recommendations (Red Book).

The Red Book states that ambulatory blood pressure monitoring or self-medication should be used, if possible, for patients with suspected white coat hypertension.

An article from 2013 on Doctor of the Australian Family is also recommended, "Patients diagnosed with white coat hypertension will require confirmation of diagnosis by repeated outpatient monitoring at six months, continuous surveillance by repeating outpatient monitoring every 1-2 years, and continuous lifestyle modification ".

The prevalence of white coat hypertension was not consistent across studies, although previous research has suggested an overall prevalence of 13%.

By 2014-15, about six million Australians aged 18 years and older had high blood pressure, according to the Heart Foundation. Of these, more than two-thirds (68%) had uncontrolled or uncontrolled high blood pressure.

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