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 White coat hypertension is pretty common – lots of people get
stressed out around doctors and it’s not unusual for this to result
in high blood pressure readings for patients who have normal blood
pressure outside the exam room, researchers note in the Journal of
the American College of Cardiology.
When researchers examined data on about 650 adults with white coat
hypertension and another group of 650 similar people without this
problem, they didn’t find a blood pressure spike at the doctor’s
office associated with an increased risk of heart disease for people
under 60 years old.
But among adults 60 and older with other risk factors such as
diabetes, obesity or a history of heart problems, people who also
experienced white coat hypertension were more than twice as likely
to experience cardiac events like a heart attack or stroke in
subsequent years.
The findings suggest “that white coat hypertension is by no means a
clinically innocent condition, although its association with an
increased risk of cardiovascular events (myocardial infarction,
stroke, heart failure, etc.) has been found in some studies but not
in others,” said Dr. Giuseppe Mancia, author of an accompanying
editorial.
Even though there’s no evidence to suggest patients with white coat
hypertension would benefit from drugs to lower their blood pressure,
these individuals should be closely monitored because their risk of
heart problems may be higher than other people who have normal blood
pressure in day-to-day life, Mancia, a researcher at the University
of Milano-Bicocca in Italy, added by email.
Some previous research has found white coat hypertension occurs more
frequently in older patients and the difference between the blood
pressure readings at the doctor’s office and outside a clinical
setting gets larger with age, authors of the current study note.
To find out if white coat hypertension is tied to an increased risk
for heart disease, researchers examined data from an international
database on blood pressure and cardiovascular outcomes.
They followed half of the people for at least 10.6 years.
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There was no difference in the number of new heart-related health
events between younger subjects with normal blood pressure and those
with a similar profile and white coat hypertension.
A difference was seen among older patients. Out of 92 high-risk
subjects age 60 and older, there were 18 more new cardiovascular
events in the follow up period among those diagnosed with white coat
hypertension compared to those with otherwise similar risk profiles
and normal blood pressure.
Researchers said the results support the hypothesis that a small
number of patients considered to have white coat hypertension
actually have isolated systolic hypertension, a common condition
where the top number in the blood pressure reading (systolic blood
pressure) is too high, but the bottom number (the diastolic blood
pressure) is normal. Isolated systolic hypertension can be an
indicator of risk for future heart disease or stroke.
The authors conclude that multiple blood pressure readings,
including readings outside a clinical setting, are necessary to
accurately identify cardiovascular risk, especially in older
high-risk patients.
SOURCE: http://bit.ly/2fG3ebJ and http://bit.ly/2g1Ab31 Journal of
the American College of Cardiology, online November 8, 2016.
[© 2016 Thomson Reuters. All rights
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