By Dr. W. Gifford Jones
January 22, 1989
How many people are being treated for high blood pressure who don't actually suffer from it? I've often wondered. But I've never seen scientific proof that some patients are being treated needlessly for this condition. A recent report in the Harvard Medical School Health Letter has finally ended such speculation. Its research won't win the Nobel Prize. But its conclusion can be of great value to medical consumers when the doctor says," You're blood pressure is up today and you need medication." The advice may be valid. But on occasion patients have developed "Whitecoat Hypertension."
The medical profession has known for years that everyone's blood pressure varies during the course of 24 hours whether or not hypertension has been diagnosed. For instance, if you're not dreaming about Dracula , the blood pressure falls while sleeping. During an active day, blood pressure increases, but usually within normal limits.
The Harvard Health Letter reports that researchers at Cornell University studied people with normal, borderline and elevated blood pressures. The subjects had their blood pressures recorded by a male physician on two separate occasions. In the interim the blood pressure was taken by an automatic recorder worn on the patient's arm. In addition a pressure reading was taken by a female medical technician who also compared it with the recorder.
The result? The highest blood pressures were those taken by physicians. Researchers then discovered that some people were hypertensive only when the blood pressure reading was taken by a physician. These people had normal pressures when away from the doctor's office. And the stress of their work did not cause the pressure to rise. Thus they were labelled as having "White- Coat Hypertension."
Patients with "White-Coat Hypertension" were most often females. They weighed less and had been diagnosed as having high blood pressure for a shorter period of time.
This is good news for some patients currently on medication for this problem. For instance, 21 per cent of borderline hypertensives and 5 per cent of those diagnosed as having "essential hypertension" had normal blood pressures when taken by the machine.
During the past 10 to 20 years the incidence of cardiovascular disease has decreased by 25 to 30 per cent. Some of this improvement has resulted from tossing away cigarettes, eating lessÔ 0*0*0* meat, shedding excess pounds and increasing exercise. But the active treatment of hypertension has been a major factor in lowering the number of deaths from strokes. It's not the intention of this column to suggest that those taking blood pressure medication should throw it away.
But this research should focus the attention of both doctors and patients on one important point. It's often reported that a good 25 per cent of hysterectomy, hemorrhoid and tonsillectomy operations are not required. Now we can add that one in four patients may be receiving pills for a hypertension problem that does not exist.
Nor should this research come as a major shock. We have known for some time that people under stress show a significant increase in blood pressure. For instance, the blood pressure of astronauts shoots sky high just as they are blasted off into space. Even seasoned television performers can't keep their pressure under control during final seconds of the countdown. Obviously the white coat is just as menacing for some people.
What would I do if my doctor said, " Giff the deadlines have given you a stomach ulcer, tension headaches and insomnia. Now it's finally given you hypertension. This prescription will bring the pressure down." I'd accept it quickly and happily if my blood pressure was considerably above normal. I might also take a second look at the need for deadlines.
But suppose the doctor said it was "slightly elevated". I'd graciously decline medication for the moment. Instead I'd find a hospital that had an automatic recorder to monitor my blood pressure for 24 hours to determine if my colleague was scaring me half to death.
If the automatic recorder revealed "slight" hypertension, I'd begin by correcting any lifestyle problems. I's shed pounds if I was overweight. I'd eliminate cigarettes which can increase the blood pressure 10 points with the effect lasting 10 minutes. I'd realize that the caffeine in two to three cups of tea or coffee raises the pressure 10 to 14 points. I wouldn't give up a cocktail before dinner which has no effect on blood pressure. But I'd respect research studies that reveal blood pressure increases in those who consume more than three alcoholic drinks a day. I'd go easy on salt. And I'd start an exercise program for 30 minutes three times a week which has proven to decrease blood pressure. I'd accept medication only after these measures failed.
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com
My book, �90 + How I Got There� can be obtained by sending $19.95 to:
Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1
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