Quite a number of patients were referred to me the last few weeks for the management of high blood pressure (hypertension) which had proved somewhat resistant to medications. Their blood pressures had been recorded high by their attending doctors. Those with their own blood pressure machines had protested that their readings were quite normal at home although their doctors insisted otherwise.
Fact: A third of hard-to-treat high blood pressure may actually be ‘fake’ and instead a patient’s nervous response to being seen by a doctor, as reported recently (here). This phenomenon has been known for some time and fondly called white-coat hypertension, in reference to the fact that quite a number of people with normal blood pressure developed nervous tension or stress when they were confronted by a doctor; which in turn is reflected by raised blood pressure readings, albeit temporary. When they were removed from the stress situation, blood pressure quickly reverted to normal levels, which accounts for the normal readings such patients obtain with their own machines when at home.
In some of these patients, blood pressure medications were actually prescribed which caused severe side-effects when they returned home and blood pressure normalised. Medications are quite unnecessary in such cases.
How does one make sure that one’s blood pressure is truly high and not due to stress-induced causes? Simple, in most hospitals, doctors can ask patients to wear a device that monitors the blood pressure regularly over 24 hours (24-hour portable ambulatory blood pressure monitoring). Today’s devices are not so bulky and cumbersome and can often resemble a wrist-watch.
The really bigger problem is trying to get those who have not gotten a blood pressure reading for many years on the mistaken belief that they did not have symptoms (hypertension is usually silent – hence the acronym ‘silent killer’) or were simply unaware that they were at risk.