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White-Coat Hypertension Not Benign

Study Shows Condition Doubles Risk for Sustained High Blood Pressure
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WebMD Health News

June 29, 2009 -- New research suggests that approximately one in six adults exhibit "white-coat" hypertension, meaning that their blood pressure is high when their doctor checks it, but normal the rest of the time.

Additionally, close to one in 10 people have a less well understood condition known as "masked" hypertension, in which blood pressure readings are normal in the medical setting but sporadically high in real life.

Both conditions have been thought by many to have little relationship to true hypertension risk, but the new study finds otherwise.

Participants with white-coat hypertension at the start of the study had more than double the risk of having sustained hypertension a decade later, compared to those with normal blood pressures. Those with masked hypertension had a 78% higher chance of developing sustained high blood pressure readings over time.

The study is the first to show that white-coat hypertension and masked hypertension are associated with clinically meaningful high blood pressure, which is a major risk factor for heart attack and stroke.

"This means that these conditions are by no means clinically innocent, as they have often been thought to be," study researcher Giuseppe Mancia, MD of the University Milan-Bicocca says in a news release.

White-Coat Hypertension Is Common

The study by Mancia and colleagues included 1,412 adults (aged 25 to 74) followed for 10 years in an ongoing health trial.

In addition to blood pressure readings obtained in the clinical setting, readings were also obtained with two widely used out-of-office tests -- ambulatory monitoring, which involved automated testing every 20 minutes over a 24-hour period, and sporadic home monitoring, using a lower-tech portable monitoring device similar to those available for purchase in drug and medical supply stores.

After 10 years, more than 40% of study participants who originally had white-coat hypertension or masked hypertension developed sustained high blood pressure readings, compared to 16% of those with normal blood pressures at the start of the study.

After adjusting for age and sex, the researchers concluded that the risk of developing sustained hypertension was 2.5 times higher in the white-coat group and 1.8 times higher in those with masked hypertension.

The study appears in the August issue of the American Heart Association (AHA) journal Hypertension.

Cardiologist Richard Stein, MD, tells WebMD that the study offers good evidence that white-coat hypertension and masked hypertension are clinically relevant.

Stein is a professor of medicine at New York University and a spokesman for the AHA.

Getting an Accurate Reading

Stein says patients who think their in-office blood pressure readings may be too low or too high should check their blood pressure at home.

Home monitors can be purchased for as little as $20, but it is a good idea to bring the device to your doctor's office to make sure that it is accurately calibrated.

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