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High Blood Pressure Overlooked in Many Patients

CardioSmart News

Having a normal blood pressure at the doctor’s office doesn’t mean you’re in the clear, according to research linking gray areas of high blood pressure to increased risk for heart disease and even death.

Published in the Journal of the American College of Cardiology, this study looked at outcomes related to two forms of high blood pressure—white coat hypertension and masked hypertension. White coat hypertension occurs when a patient’s blood pressure spikes at the doctor’s office but is normal at home. Masked hypertension, on the other hand, occurs when a patient has high blood pressure at home but normal levels in the doctor’s office. While studies have raised concerns about the impact of both conditions on heart health, it remains unclear whether patients with white coat or masked hypertension should be treated as aggressively as those with standard high blood pressure.

To learn more about the issue, researchers analyzed data from the Dallas Heart Study. Established in 2000, this study followed a diverse group of Texas residents to learn about factors related to heart disease—the No. 1 killer of men and women in the United States.

A total of 3,027 adults were included in the most recent analysis, all of whom were followed for nine years. During the study period, participants had their blood pressure tested both in the doctor’s office and at home and provided key information about their health and lifestyle. Researchers also used various tests like MRIs and blood tests to assess participants’ organ function and overall health during the study.

After tracking participants for nine years, researchers found that 18% of participants had masked hypertension and 3% had white coat hypertension. Both conditions were associated with poorer organ function and higher risk for heart events than patients with normal blood pressure. In fact, patients with white coat hypertension and masked hypertension had double the risk for heart events than patients with normal blood pressure.

Upon further analysis, researchers also noted differences between outcomes in white versus black adults. While white coat hypertension didn’t raise cardiovascular risk significantly among white adults, it did increase risk for black study participants. However, this difference was not considered statistically significant and warrants further research.

As authors explain, findings support the use of home blood pressure monitoring to improve diagnosis and treatment of high blood pressure. It’s clear that blood pressure readings in the doctor’s office don’t provide a complete picture of a patient’s blood pressure. Blood pressure changes throughout the day and can vary between the doctor’s office, home and everywhere in between. As a result, conditions like white coat hypertension can increase risk for heart events. With improved testing and diagnosis, experts hope to better treat patients with all forms of high blood pressure to reduce cardiovascular risk.

Read the full article in the Journal of the American College of Cardiology. Learn about CardioSmart's editorial process. Information provided for educational purposes only. Please talk to your health care professional about your specific needs.