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.