High Blood Pressure in the Doctor’s Office

A certain person in my life who will remain nameless - let’s just call him the Dude - gets pretty stressed out when he goes to the doctor’s office. Not that you could tell from the outside. Raised in the California sunshine, the Dude is seemingly as chillaxed and cool as people come. But one step inside the medical clinic and his blood pressure goes through the roof. Which makes it pretty hard for a doctor to assess his actual blood pressure.

Funnily enough this syndrome actually has a name - White Coat Hypertension. The term was coined in 1983 by Giuseppe Mancia and his colleagues at the University of Milano-Bicocca in Italy after they showed that blood pressure can drop 27/15 mmHg (millimeters of mercury) after a doctor leaves their patient’s hospital room.

So today, the Dude is sporting a portable blood pressure cuff that will measure his asystolic/diasystolic pressure for 24 hours as he moves through his normal daily routines. This is called ambulatory (walking) blood pressure monitoring, which some cardiologists argue is the single best predictor of cardiovascular disease/damage/mortality compared to doctor’s office/casual at-home readings. Nice.

It will be interesting to see the Dude’s assessment; white coat hypertension was previously thought benign, as blood pressure drops to normal once the patient leaves the doctor’s office. But a growing body of evidence suggest that those who with WCH might be at increased risks of cardiovascular disease. For example, a 1996 study in the Lancet found that patients with WCH show similar cardiovascular functioning/abnormalities to those with consistently raised blood pressure. Likewise, the 1998 paper from the British Medical Journal found that patients with WCH had thicker walls surrounding their left (whole body pumping) ventricle. This is a sign of heart stress/over working.

Bad.

So if his BP profile is like, low and healthy and healthy all day long and really only spikes with an MD in the room, then maybe he can escape treatment. But if he’s edging towards the upper boundaries of normal (between 130/80 to 140/90) does this mean pills/a salt-free diet for the Dude? Well maybe he could just try transcendental meditation?