White Coat Hypertension and Anxiety

'White-coat' Hypertension Not Often a Major Concern

Reuters Health

By Martha Kerr

Friday, May 2, 2003


NEW YORK (Reuters Health) - "White-coat hypertension" -- a spike in blood pressure that occurs only in a doctor's office -- is rarely a cause for concern, researchers reported this week at a meeting of the Inter-American Society of Hypertension in San Antonio, Texas.

In a study of people referred to a hypertension clinic, most people who had blood pressure readings of 200 millimeters per liter of mercury (mmHg) or higher during an office visit actually had much lower blood pressure, reported Dr. Mihaly Tapolyai of the Cleveland Clinic Florida in Weston.

For people who get an extremely high blood pressure reading in a doctor's office, it would be a good idea to monitor their blood pressure throughout a 24-hour period before beginning treatment to be certain that the high reading isn't white-coat hypertension, according to Tapolyai.

Tapolyai and associates followed 57 people whose average systolic blood pressure (the top number in a blood-pressure reading) was at least 200 mmHg at office visits. But when blood pressure was monitored throughout the day using a device worn on the body, the average systolic pressure was about 151 mmHg -- still high, but much lower than in a doctor's office.

In comparison, a group of 80 patients with confirmed high blood pressure had an average systolic blood pressure of 146.1 mmHg during office visits and 137.9 on 24-hour monitoring. Blood pressures below 120/80 mm Hg are considered within a normal, healthy range

Tapolyai reported that only 5.3% of the patients with severe office hypertension were determined to have so-called grade IV systolic hypertension, with systolic blood pressures of 200 mmHg or greater more than 20% of the time. Meanwhile, 7% of those with severe office hypertension proved to have normal blood pressure on 24-hour monitoring.

Tapolyai pointed out in an interview with Reuters Health that the consequences of hypertension, such as congestive heart failure, stroke and death are associated with sustained high blood pressure -- not office hypertension.

He warned that treating white-coat hypertension without confirming that a person truly has high blood pressure may cause a person's blood pressure to drop below normal. "The time has come to measure blood pressure with an ambulatory blood pressure monitor," especially in certain circumstances such as newly diagnosed cases of high blood pressure, high blood pressure that does not respond to treatment, episodic hypertension that affects people having an anxiety attack, white-coat hypertension or unusual circumstances like high blood pressure in the young, Tapolyai said.

Standard measurement of blood pressure is acceptable for screening and for follow-up once high blood pressure has been established with 24-hour monitoring, he added.

New Haven- There is a pretty high correlation between people who are chronically stressed and under tension, and HBP!