We’ve all heard of those people who, without fail, have high blood pressure when they come for their check-up at the doctor’s office. They promise their blood pressure is normal when they leave and check it elsewhere. Perhaps they are just a bit anxious from being at the doctor’s office. This is something we commonly call “White Coat Hypertension.”
What about people who may have normal blood pressure readings while they are at the doctor’s office but a high blood pressure anytime else? This is called masked hypertension. It would be dangerous to miss something like this, so this is one reason I always encourage my patients to check their blood pressure periodically outside of the office either with an at-home BP cuff or when they are at their pharmacy.
Now, we have more evidence to show that ambulatory blood pressure monitoring, where blood pressure cuffs are worn and readings are taken over a 24 hour period as you go about your normal daily life, are better predictors of cardiovascular-related mortality.
An article published recently in the New England Journal of Medicine highlighted a study by researchers from Spain who investigated blood-pressure data from 64,000 adults. These patients underwent ambulatory blood pressure monitoring and were then followed for around 5 years. What researchers concluded was ambulatory blood pressure monitoring predicted mortality more so than blood pressures taken during doctor’s visits (or clinic blood pressures). Masked high blood pressure, or blood pressure that was normal in clinic but otherwise high, predicted cardiovascular-related deaths as strongly as did sustained high blood pressure.
Perhaps most interesting was that untreated patients with “white coat hypertension” were associated with a higher mortality rate than those patients who were on blood pressure medications for the same condition.
What does all of this mean?
Well, it likely means that you will start to see a shift in how we view blood pressure monitoring and how we measure your blood pressure. Don’t be surprised next time you’re at the doctor and he or she wants you to have 24-hour ambulatory monitoring to make sure your blood pressure is in check both inside and out of the office.
Jeremiah Robinson PA-C is a licensed and certified Physician Assistant with T. Douglas Gurley MD in Atlanta, GA.