People with white coat hypertension are more likely to die from cardiac events


FIn recent decades, doctors were aware of a phenomenon called "white coat hypertension" – when a patient had higher blood pressure readings at the doctor's office than at home, perhaps because they were anxious at the clinic – but previous studies have shown it. showed inconsistencies in its effects.

Now, a major new meta-analysis confirms that patients with this condition are more than twice as likely to die from a cardiac event than those whose blood pressure readings are still normal.

According to the study published Monday in Annals of Internal Medicine, these same patients have an increased risk of death by 33% and a 36% greater risk of experiencing a cardiac event, such as a heart attack.


The analysis, which drew data from 27 studies on the disease, draws a much clearer picture of the issue than a single study had done, noted the authors. The results are also particularly important for public health efforts to combat heart disease and stroke, with hypertension being a known risk factor for these events, but with no known symptoms. Some researchers have also emphasized the importance of accurate monitoring of blood pressure by patients.

"We simply wanted to clarify the real risk of high blood pressure in isolated offices with normal blood pressure at home," said Dr. Jordana Cohen, first author of the journal and assistant professor at the Perelman School of Medicine. University of Pennsylvania. "It brings together the results to give us, in a way, a stronger sense of what's really the signal."

The study also identified two types of patients whose blood pressure readings were abnormal in the doctor's office – some were receiving medications to lower their blood pressure and others not. Those who had taken medication showed no increased risk of cardiovascular events or deaths compared to those with normal blood pressure.

Cohen said the two results combined should prompt physicians to more closely monitor patients with white hypertension if they were not taking medication – but also that they might treat people with similar values ​​too much if they were receiving antihypertensive medications.

"In most situations, [patients who get medication] may be more prone to the side effects of high blood pressure or low blood pressure medications resulting from their medications for hypertension, "said Cohen.

This finding calls into question the proper treatment of hypertension in white coat, she said, stressing the importance of further studies to determine the type of interventions that could be the best.

"We do not know if treatment with high blood pressure medication will help," she said. "You do not want your blood pressure to be low outside the office, because normally their blood pressure is normal outside the office. But we do not know what to do about it. "

Prior to this meta-analysis, many previous studies did not distinguish between patients with these outcomes who received medications and those who did not, according to Cohen.

The study also divided the patients into subgroups. Cohen and his colleagues found that the risk of cardiovascular events or mortality was also high when study patients were older, when the duration of the study was five years or more, and when ambulatory blood pressure monitoring systems were used. home blood pressure monitoring systems, compared to patients whose blood pressure was still normal.

Several researchers who were not involved in the new article cautioned that meta-analyzes like this one often take into account too many variables. Dr. Stanley Franklin, retired professor at the University of California, Irvine, who has published numerous studies on white blood pressure, also pointed out that some of the included studies may have performed valid analyzes and robust, while others may not have it – compromising integrity. meta-analysis as a whole.

Cohen argued that while this might be true in some cases, the inconsistency in the data they had was exactly why a meta-analysis was needed – "because you're never going to design a single study that obtain each of these studies. problems."

She pointed out that even when different studies were excluded from subgroup analyzes, the main results remained consistent, making researchers "much more convinced that these results are real".

"When you collect all the results of each available study, regardless of your selection method, and if you are very very rigorous about the quality of the studies, you always end up finding that untreated hypertension is associated at this increased risk, while the white coat effect treated [is] not, said Cohen.

Paul Munter, who co-wrote an editorial on the study, said it was an important study because it "synthesizes the most recent data" and shows the ## 147 ## ######################################################################## The importance of blood pressure control outside offices.

"Once people start taking medications to lower blood pressure, they will stay there all their lives. It is therefore always helpful to have additional information about a person's blood pressure before asking him to take medication for the rest of his life. Munter, associate dean of research at the University of Alabama, told the Birmingham School of Public Health.

Cohen and others also hope that the research will encourage insurers to cover ambulatory sphygmomanometers, in which patients wear a belt around the body, attached to an armband on the upper arm, and who periodically measure blood pressure . At present, most physicians rely on home blood pressure monitoring, which they refer to the patient. This can be wrong – when patients take their own blood pressure readings, they often forget or delete the measurements they do not like datasets, which makes the data less reliable.

But ambulatory monitors are expensive and few insurers cover them.

Dr. William White, former president of the American Society of Hypertension, said the new data highlight their importance – and their relative value. Preventing cardiac events such as stroke or heart attacks could save the health system much more than the cost of devices over time.

"It's silly not to want to cover this test, because in the long run it will pay for itself," he said. "This [study] actually increases the knowledge of the importance of accurately diagnosing people. You just need to know what they really are, because if you can not understand that, it's impossible, you guess. "

At the moment, Cohen recommends people with white coat hypertension to adopt a better diet and exercise, while regularly monitoring their blood pressure outside the office, while keeping in the spirit that it is a precise blood pressure measuring device – a list of which will be provided. this summer from the American Medical Association.

"There is currently no smartwatch, which can test blood pressure without a cuff, such as a blood pressure cuff," Cohen said. "And so it's very important to be a wise consumer about these things."


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