Anybody who owns a blood pressure monitor will probably tell you that blood pressure readings can vary widely from measurement to measurement. Furthermore, for decades, physicians have known about "white coat hypertension," an anxiety-ridden phenomenon whereby patient blood pressures spike in the presence of a health care provider (wearing a "white" coat).
Researchers at the Durham Veterans Affairs Medical Center followed blood pressure readings of 444 veterans for 18 months. These researchers tested blood pressures in a variety of settings including the lab, the clinic and at home. As expected, blood pressures varied widely. The researchers recommend that high blood pressure (hypertension) treatment regimens be tailored to take several measurements--including those taken at home--into consideration.
For years, evidence-based guidelines have advised physicians to diagnose hypertension in their patients only after two hypertensive readings taken during two separate visits.
Patients are usually diagnosed and treated for hypertension as follows:
• Prehypertension: 120/80-139/89. Treated with diet and exercise unless the person also has diabetes, cardiac or renal disease.
• Stage 1 hypertension: 140/90-159/99. Treated with medication.
• Stage II hypertension: Greater than or equal to 160/100. Typically treated with more medication.
Of note, the numerator (top number) in these readings is defined as the systolic pressure, and the denominator (bottom number) is defined as the diastolic pressure.
The findings of this hypertension study suggest that the treatment of high blood pressure may be less straightforward than previously thought. Maybe people need a more global assessment of blood pressure (including a log of at-home and at-work readings) before they can be effectively treated. Something to think about ...
Sources: "Measuring Blood Pressure for Decision Making and Quality Reporting: Where and How Many Measures?" Powers et al, Annals of Internal Medicine, June 21, 2011
Boards and Wards, Fourth Edition, Carlos Ayala and Brad Spellberg
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