A recent study by Britain’s NHS suggests that many patients are diagnosed as having high blood pressure when they really don’t. A professor from University of Leicester says that blood pressure taken in a clinical setting (doctor’s office) is affected by “white coat hypertension” more than previously thought. White coat hypertension is the term used for persons who’s BP becomes elevated due to the stress they experience simply by being in the doctor’s office.
As expected, most cases of elevated blood pressure are diagnosed by the doctor in his office. This new revelation may mean that thousands of people who have been diagnosed and treated for pre-hypertension may in fact have normal pressure.
Home blood pressure monitoring recommended
The recommendation from the Blood Pressure Association (the UK version of the American Heart Association) is the use of home blood pressure monitors. Monitoring pressure in the familiar and comfortable setting of a person’s home minimizes the chances of a reading being influenced by stress and anxiety. Most modern blood pressure monitors are semi or fully automated and easy to use.
In the UK where the government offers universal health care the impact of over diagnoses and treatment is as much financial as it is medical. If a person is diagnosed as pre-hypertensive and also suffers from white coat hypertension, repeated trips to the doctor’s office will simply exacerbate the problem and use up limited medical resources. In addition, any drug prescribed for the condition (usually a diuretic) is paid for by the NHS.
A clinically validated monitor costs between $45 and $90 which is much less expensive than repeated visits to the doctor. In addition, if medication can be reduced or eliminated that cost, as well as the potential side effects, goes away.
Lessons for US treatment for elevated pressure
The lesson to be learned by the rest of the world, particularly the United States where over 50 million people are thought to have high blood pressure, is that home pressure monitoring may reveal the same kind of over diagnosis. In the past artificially elevated pressure was explained as the anxiety of being in a doctor’s office. Today there are additional stressors that are tied to the economic environment.
A trip to the doctor with reduced or no insurance benefits now represents an unplanned expense that can have potentially a significant financial impact on the patient and his or her family. Anxiety is becoming the norm.
If the NHS findings are correct, then it would seem to be logical for all persons diagnosed with high BP to use a home blood pressure monitor to get an accurate reading to their condition. This can result in a reduction in over medicating, stress and by engaging the patient in their condition, an increase in their awareness to diet, exercise and lifestyle.
Does this article make sense to you? Do you experience anxiety when you visit the doctor? Could it be that your blood pressure isn’t as high as your doctor thinks? Have you been prescribed a higher dose of medication than you need based on pressure readings that are artificially elevated because of nerves?