My 87-year old father is about to have knee replacement surgery so he has been getting his pre-op education and work up by nurses, physiotherapists and occupational therapists through the highly impressive, comprehensive Osteoarthritis Service Integration System (OASIS) program based at the University of B.C. Hospital.
At one recent appointment, his blood pressure was high even though his pills usually do a good job controlling his hypertension.
The nurse who took his reading quite rightly advised him to see his family doctor about whether he should increase the dosages of his hypertension medications. So he made the appointment and when he was checked in the more familiar surroundings by his family doctor of many years, the pressure was normal.
What he undoubtedly had when the nurse took his reading is called “White coat hypertension“ and it is a recognized occurrence in which patients have elevated blood pressure in a doctor’s office but not when they take readings in the comforts of their own home or settings where they are not experiencing transient anxiety.
It’s been estimated a third of all patients get so anxious when doctors take their blood pressure that they have artificially high readings. It is a fleeting condition in which the simple act of having a medical professional take one’s blood pressure causes it to rise, giving a false positive diagnosis.
In the September/October Annals of Family Medicine, Martin G. Dawes of the department of family medicine at McGill University and his co-researchers from the University of Sydney and the University of Oxford found in their study which included data from over 5,000 patients that those with fleeting, white coat hypertension had a 36 per cent lower risk of death than patients with sustained hypertension (those who had high readings in a clinical setting a mean of three times in the previous six months).
That’s an important finding because it’s a reminder to health professionals that they need to evaluate patients in greater depth before prescribing or increasing medications, especially since such pills can have side effects like dizziness. The study findings also recognize the importance of home-based blood pressure monitoring as an important tool for unbiased measurement.
The take away message here is that if you’ve got high blood pressure and you don’t test yourself routinely at home or in a relaxed setting like your neighborhood drug store, you should start now.