High blood pressure at the doctor's office may mean you are twice as likely to die from heart disease


Patients with this condition who do not take medications for hypertension are twice as likely to die of heart disease as patients with normal blood pressure, according to a meta-analysis published in the Annals of Internal Medicine.
Blood pressure is a measure of the force in which blood flows through our veins, arteries and capillaries, and when this force is too great, is called hypertension or high blood pressure. In numbers, the high blood pressure is considered somewhat above 130/90. The first number, the systolic pressure, reflects the pressure in the vessels when the heart beats. The second number, diastolic, measures when the heart is at rest.

Doctors do not know what causes white coat hypertension, which may have different triggers in different patients. For some people, anxiety can cause blood pressure to rise in a medical setting, but others may have fluctuating blood pressure due to an underlying physiological condition.

About 1 in 5 American adults may have white coat hypertension, the research suggests. To understand the health risks, researchers at Penn Medicine reviewed 27 studies involving more than 64,000 patients in the United States, Europe and Asia. Compared with people with normal blood pressure readings at home and in the office, patients with white coat hypertension were at increased risk for cardiovascular events and death.
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Patients with untreated white coat hypertension had a 36% increase in heart disease risk, a 33% increase in the risk of death from any cause, and a 109% increase in the risk of death from heart disease, according to the analysis.

This finding was "more robust" in studies where participants were on average 55 years or older and studies that included patients with previous cardiovascular disease, according to Dr. Jordana Cohen, co-author of the study and assistant professor of medicine and epidemiology. at the University of Pennsylvania Perelman School of Medicine.

A separate group of patients with variable blood pressure readings were not at high risk – those who experienced the "effect" of the white lab coat. They are patients whose blood pressure is only high in their offices, but normal at home, and they are already taking blood pressure medication. They did not present an increased risk of cardiovascular events or mortality, the analysis showed.

Although more research is needed, "we encourage lifestyle modifications (including improved diet, exercise, weight loss, alcohol use reduction, and smoking cessation) in all patients with white-coat hypertension," the researchers concluded.

A comprehensive & # 39; and current

Dr. Daichi Shimbo, a cardiologist and associate professor of medicine at Columbia University Medical Center, said the new meta-analysis is "really important" because researchers' review of the published studies was "really comprehensive" and included recent research. Shimbo, who was not involved in the study, but co-author of an editorial published alongside the meta-analysis in the Annals of Internal Medicine, explained that "it has long been thought that white coat hypertension is benign and is not associated with risk increased. "
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The new research suggests the opposite, Shimbo said, although he noted that the finding "does not apply to everyone."

"If you were older – you were at least 55 years old – had a history of cardiovascular disease or had chronic kidney disease or diabetes, white-coat hypertension would be associated with an increased risk of cardiovascular events and mortality." he said.

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In addition, the high risk in patients with white coat hypertension is "not strong, not weak, somewhere in between," said Shimbo, who questioned the risks for people not included in the analysis: those with sustained hypertension in and outside the doctor's office).

Drawing data from the articles examined in the meta-analysis, Shimbo and his co-author, Paul Muntner, director of research at the University of Alabama at Birmingham School of Public Health, found that patients with sustained hypertension "have a substantially increased risk" . for cardiovascular events and mortality "compared to people with normal blood pressure, he said:" Makes sense, right?

The risk of cardiovascular events and death among patients with white coat hypertension is somewhere in the middle of the spectrum and is "substantially lower" than that of patients with consistent high blood pressure readings, he said.

Despite finding a high risk for cardiovascular events, including heart attacks and coronary artery disease, the meta-analysis found no relationship between white coat hypertension and stroke. "This unexpected finding may benefit from further investigation," noted Shimbo and Muntner.

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Recent guidelines in the United States and Europe recommend that blood pressure monitor white coat hypertension and the effect of the white coat, Shimbo said, and he also emphasized "the importance of out-of-office monitoring to diagnose hypertension."

Most guidelines say that outpatient monitoring – in which a patient uses a sophisticated device that automatically inflates and deflates, measuring blood pressure even during sleep – is the preferred approach, but is not available for everyone, he explained.

Home monitoring – in which a patient self-measures blood pressure, usually with a non-fully automatic shop-bought device – is more practical and helpful, Shimbo said, adding that patients need a "decent device that is need". "and to ensure that they follow the instructions.

The American Heart Association recommends an automatic bicep monitor (arm) that has been validated – ask your pharmacist for advice – and offers tips on how to use it properly.


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