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PHILADELPHIA – White coat hypertension, a condition in which a patient's blood pressure readings are higher when taken in the doctor's office compared to other settings, has been attributed to anxiety that patients may feel during their medical appointments. However, over the years, research has suggested that high readings could be a sign of underlying risk of future health problems. A new study led by Penn Medicine researchers, published today in the Annals of Internal Medicine, found that patients with untreated hypertension had an increased risk of heart disease, but that they were twice as likely to die of heart disease as others. with normal blood pressure.
The researchers also found that patients with white hypertension who were taking drugs to treat their high blood pressure, called antihypertensives, did not have an increased risk of heart disease or death related to the cardiovascular system compared to those whose blood pressure was normal.
"Studies suggest that about one in five adults may have white hypertension.Our findings highlight the importance of identifying people with this disease," said the leading author of the study. study, Jordana B. Cohen, MD, MSCE, Assistant Professor at Renal Division. -Electrolyte and Hypertension and Senior Scientist at the Center for Clinical Epidemiology and Biostatistics. "We believe that people with isolated hypertension in the office – those who do not take medication for blood pressure – should be closely monitored to detect a transition to prolonged hypertension." or high blood pressure both at home and at the doctor. "
High blood pressure, or high blood pressure, is defined as a maximum reading of at least 130 or a lower value of 80. This disease affects nearly one-third of US adults and, if it is not treated, increases the risk of serious complications, including heart attacks. and stroke. In order to diagnose and manage the condition, recent hypertension recommendations strongly recommend monitoring blood pressure outside the office, such as home monitoring and ambulatory blood pressure monitoring, which require patients to wear a portable device that records blood pressure readings over a 24-hour period. hour time. However, providers have been slow to adopt this practice, in part because of skepticism about the utility of screening for white coat hypertension, given conflicting results from previous studies, as well as uncertainty about its badociation with heart disease and death.
To identify the cardiovascular risks of white coat hypertension, the researchers conducted a meta-badysis of 27 studies involving more than 60,000 patients and badessing the health risks badociated with this condition. They found that patients with white hypertension on the untreated coat exhibited an increased risk of heart disease by 36%, an increased risk of death by 33% and an increased risk of cardiac death by 109%.
"Our findings confirm the urgent need for increased blood pressure monitoring off the office across the country as it is essential for the diagnosis and management of hypertension," said Cohen. "At the same time, we advise people with untreated white coat hypertension to change their lifestyle, including giving up smoking, reducing their alcohol intake and improving their smoking habits." diet and their exercise programs We also recommend that providers do not over-treat people with a white coat, hypertension, who are already taking blood pressure medications, as this could lead to dangerous low blood pressure outside the office and unnecessary side effects of the drugs. "
The researchers noted that future studies would be needed to study interventions to reduce the cardiac risk of hypertension in white coats.
This work was funded in part by a grant from the National Institutes of Health (K23-HL133843). Matthew G. Denker, Debbie L. Cohen and Raymond R. Townsend are other authors.
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Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman Medical Schools of the University of Pennsylvania (founded in 1765 as the country's first medical school) and the University of Pennsylvania Health System, which together form a 7 $ 8 billion.
According to the US News & World Report's study of research-based medical schools, the Perelman School of Medicine has been one of the top medical schools in the United States for more than 20 years. The School consistently ranks among the top recipients of funding from the National Institutes of Health in the country, with $ 425 million awarded during fiscal year 2018.
The patient care facilities of the University of Pennsylvania Health System include: the University of Pennsylvania Hospital and the Penn Presbyterian Medical Center, recognized as one of the best hospitals of the country by the "Honor Ranking" by the US News & World Report – Chester County Hospital; Lancaster General Health; Penn Medicine Princeton Health; and Pennsylvania Hospital, the country's first hospital, founded in 1751. Other facilities and companies include Good Shepherd Penn Partners, Penn Home Care and Hospice Services, Lancaster Behavioral Health Hospital and Princeton House Behavioral Health. , among others.
Penn Medicine is powered by a talented and dedicated workforce of more than 40,000 people. The organization has also forged alliances with the best community health systems in southeastern Pennsylvania and southern New Jersey, creating more options for patients regardless of where they live. .
Penn Medicine is committed to improving living conditions and health through various community programs and activities. During the 2018 fiscal year, Penn Medicine has provided more than $ 525 million for the benefit of our community.
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