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Study: Treatment-Resistant Hypertension Overdiagnosed

Some Patients May Have 'White Coat' Hypertension Instead

Question of Cost continued...

“We go through a whole inventory,” Giles says. “If your pressure is high in the office and there is nothing else associated with it, it’s always fair to say ‘do you think I may have excitement?’” or white coat hypertension.

Other factors include the use of certain types of drugs and high-salt diet, which may affect blood pressure or treatment.

Dana Simpler, MD, an internist at Mercy Medical Center in Baltimore, says that ambulatory monitoring is important, but it’s not always covered by insurers. “I would love to send them out with a 24-hour cuff and find out their readings, but that doesn't always happen.”

To circumvent insurance issues, Simpler has some patients purchase a home blood pressure cuff and bring it to the office to make sure it is accurate, and then has them record their blood pressure at home.

“When it is up in the office and normal at home, we do nothing,” she says. In these cases treatment may cause low blood pressure, which can result in lightheadedness and fainting.

‘Masked’ Hypertension

The new findings seem plausible to Robert A. Phillips, MD, PhD, director of the Heart and Vascular Center of Excellence and senior vice president of UMass Memorial Medical Center in Worcester, Mass.

“If they don’t have diabetes, kidney disease, are not a smoker, and don’t have sleep apnea and other target organ damage, then we can say go ahead and do home monitoring to see if they have white coat hypertension,” he says.

While white coat hypertension does not typically require treatment it should still be monitored every year, Phillips says.

The opposite of white coat hypertension is masked hypertension. This occurs when blood pressure is normal in the doctor’s office, but elevated elsewhere, he explains.

“We don’t have enough data to say what to do about masked hypertension, but people with masked hypertension may be the ones who need ambulatory monitoring because these people think they are well-controlled, but they are not and may be a higher risk,” he says.

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