High blood pressure at the doctor's office can mean that you are twice as likely to die from heart disease


The meta-analyzes published Monday in the Annals of Internal Medicine reveal that patients with this disorder who do not take medication for hypertension are twice as likely to die of heart disease as patients on normal pressure.
Blood pressure is a measure of how much blood flows through our veins, arteries and capillaries. When this force is too important, one speaks of hypertension or hypertension. In figures, high blood pressure is considered greater than 130/90. The first number, the systolic pressure, reflects the pressure in the vessels when the heart beats. The second number, diastolic, measures the moment when the heart is at rest.

Doctors do not know what causes white coat hypertension, which can have different triggers in different patients. For some people, anxiety can cause an increase in blood pressure in a medical setting, while others may have fluctuating blood pressure due to an underlying physiological condition.

About 1 in 5 American adults may have white blood pressure, according to research. To understand health risks, Penn Medicine researchers reviewed 27 studies involving more than 64,000 patients in the United States, Europe, and Asia. Compared with people whose blood pressure was normal at home and in the office, patients with white haired hypertension had a high risk of cardiovascular events and deaths.
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Patients with white hypertension had an increased risk of heart disease, 33%, 33%, and 109%, according to the analysis.

According to Dr. Jordana Cohen, co-author of the study and assistant professor of medicine and epidemiology, this finding was "very robust" in studies where participants were on average 55 years or older on average and studies that included patients with previous cardiovascular disease. at the University of Pennsylvania Perelman School of Medicine.

A separate group of patients with variable blood pressure readings were not at high risk – those with the "effect" of the white coat. These are patients with high blood pressure, but normal at home, in doctor's offices who are already taking blood pressure medications. The analysis did not show an increased risk of cardiovascular events or mortality.

While more research is needed, "we encourage lifestyle modifications (diet improvement, exercise, weight loss, reduced alcohol consumption, and smoking cessation) in all patients in whom hypertension had been declared, "concluded the researchers.

A "complete" and current analysis

Dr. Daichi Shimbo, a cardiologist and associate professor of medicine at Columbia University Medical Center, said the new meta-analysis was "very important" because the review of studies published by the researchers was both "very comprehensive" and included recent research. Shimbo, who did not participate in the study but who co-wrote an editorial published alongside the meta-analysis in Annals of Internal Medicine, explained that "it has long been thought that White coat hypertension was benign and not associated with increased risk. "
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The new research suggests the opposite, said Shimbo, although he noted that the discovery "does not apply to everyone".

"If you were older – you were at least 55 years old – or if you had a history of cardiovascular disease or if you were suffering from chronic kidney failure or diabetes, high blood pressure was associated with increased risk from cardiovascular events and mortality, "he said.

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In addition, the high risk in white coat hypertensive patients is "not high, it's not low, it's somewhere in the middle," said Shimbo, who was questioning about the risks for people not included in the analysis: those with sustained hypertension (high values ​​both inside and outside the doctor's office).

Drawing on the data reviewed in the meta-analysis, Shimbo and co-author Paul Muntner, Associate Dean of Research at the University of Alabama at the Birmingham School of Public Health, revealed that Patients with sustained hypertension "have a very increased risk for cardiovascular events and mortality" compared to people with normal blood pressure, he said: "Does this make sense, right?"

The risk of cardiovascular events and deaths in patients with hypertension "in white coats" lies somewhere in the middle of the spectrum and is "substantially lower" than that of patients with constant readings of High blood pressure, he said.

Despite the discovery of a high risk of cardiovascular events, including heart attacks and coronary heart disease, the meta-analysis revealed no relationship between white blood pressure and vascular events brain. "This unexpected discovery could benefit from further investigation," noted Shimbo and Muntner.

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Recent guidelines in the US and Europe recommend monitoring blood pressure to screen for hypertension and the effects of a white coat, Shimbo said. He also stressed "the importance of doing surveillance outside the office to diagnose hypertension".

Most guidelines indicate that ambulatory monitoring – in which a patient wears a sophisticated device that inflates and deflates automatically, measuring blood pressure even while sleeping – is the preferred approach, but is not recommended. not available to everyone, he explained.

Home monitoring – in which a patient measures his or her blood pressure, usually with a store-bought device that is not fully automatic – is more convenient and cost-effective, said Shimbo, adding that patients had to Obtain a "correct, accurate and accurate device" and ensure that they follow the instructions.

The American Heart Association recommends a validated cuff type automatic biceps (upper arm) monitor – ask your pharmacist for advice – and tells you how to use it correctly.


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