Blood pressure that rises only in the doctor's office -- so-called"white-coat" hypertension -- may be more serious thanwidely believed.
Researchers report that patients with white-coat hypertension showedsigns of heart damage similar to, but not as severe as, patientswith chronic high blood pressure.
Currently, experts remain divided on whether white-coat hypertension,which is thought to be due to the stress of a healthcare visit,is a benign condition or a sign of heart disease that should betreated.
The researchers found that the walls of the left ventricle, oneof the heart's upper chambers, appeared thicker in patients withwhite-coat hypertension, compared with those with normal blood pressurelevels. They were also more likely to show left ventricular hypertrophy,an enlargement of the chamber linked to the risk of heart attackand stroke.
As expected, those with chronic high blood pressure showed thehighest degree of damage to the left ventricle.
Although the study does not explain the underlying mechanism ofthe left-ventricle changes seen in patients with white-coat hypertension,the authors note that temporary blood pressure increases, causedby exaggerated response to mild stress may have an effect on cardiacgrowth, leading to hypertrophy.
The results of this study support the hypothesis that white-coathypertension should not be simply considered a benign condition.
At present, with our knowledge of the benefits of lowering bloodpressure and the realization that this usually does not involvecomplicated or dangerous regimens, it is good policy to treat white-coathypertensives.
Blood pressure readings are taken in two numbers. The systolicvalue (the first number in a blood pressure measurement) describesthe pressure in the heart during contraction. The second number,the diastolic value, represents the pressure when the heart is atrest between beats.
Blood pressure readings above 140/90 mm Hg are considered high.In this study, white-coat hypertension was defined as having a systolicpressure over 140 or a diastolic pressure over 90 during doctorvisits, but a regular daytime blood pressure of 130/80 or less.
Archives of Internal Medicine2001:161;2677-2681
White-coat hypertension is not a common problem, but it haslong been regarded as something that should not be treated. Thisstudy provides some compelling evidence of the damage that stressalone can cause to the heart.
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