How to know your true blood pressure in the doctor’s office? It is no secret that office blood pressure monitoring is not a reliable source to diagnose and manage blood pressure. This is true for several reasons including patient, environment, and staff issues.
Role of Office Blood Pressure
Yet accurate blood pressure measurement is essential for appropriate blood pressure diagnoses and treatment. Recent guidelines have determined that the role of office blood pressure monitoring should be for screening purposes only. Only Home, ambulatory, and automated blood pressure monitoring are recommended for hypertension diagnosing and treatment.
White Coat Hypertension & True Blood Pressure
White Coat Hypertension is seen in patients who don’t have high blood pressure and their blood pressure is elevated in the office but normal at home. These people have a low risk of poor outcomes. Whitecoat hypertension is not your true blood pressure
White Coat Effect & True Blood Pressure
The white coat effect is seen in patients who have been diagnosed with high blood pressure and treated with blood pressure medication. Their blood pressure is elevated in the office but normal at home. These people have a low risk of poor outcomes. The white coat effect is not your true blood pressure
Masked Hypertension & True Blood Pressure
Masked hypertension is seen in patients who have not been diagnosed with high blood pressure. Their blood pressure is normal in the office but elevated at home. However, if these people are not monitoring their blood pressure at home, they would go undetected. These people have a high risk of poor outcomes. It is essential for these people to do home, ambulatory, or automated blood pressure monitoring. Treatment should be prompt and aggressive in these people to reduce their risk for poor outcomes. Masked hypertension is not your true blood pressure.
Ambulatory Blood Pressure Monitoring
Home Blood Pressure Monitoring
Automated Office Blood Pressure Monitoring
Dr. Gupta explains all three types of hypertension and the importance of knowing the differences between them. Below the video are actual quotes from people who viewed his video.
“Every time when I measure my blood pressure I feel how my pulse increases immediately and I become anxious because I am afraid of the numbers”
“I went to the doctor yesterday. The doctor’s assistant walked me into a small room had me step onto a scale and then sit down and IMMEDIATELY put the blood pressure cuff on my arm. Of course, it was high—about 160/90. Later the doctor asked me if I wanted beta-blockers for [BP]. I said no. I told him the assistant did the BP wrong and that my usual BP was 120/70.”
“I’m a Critical Care nurse and I absolutely agree with you! It’s sad that many patients are being treated for the numbers rather than the symptoms, and they come back with more complications due to the side effects of medications… We need more caring doctors like you in this world. Thank you for sharing this information!”
“Thanks for addressing this. Haven’t been to a doc office for over 3 years exactly due to this reason”
“You such a kind, doctor and man. So thoughtful of you to reach out to ppl who [aren’t] even your patients.”
Additional comments
“I like your theory of educating patients instead of treating with pills–unfortunately educating patients [do] not bring in money for the medical establishment. That why we as patients do well to educate ourselves–there is so much information out there that we can avail ourselves to and be educated about health matters! It is doctors like you that help us understand health matters and educate us.”
“Wow!!! A doctor with some common sense! Thank you!!!”
“Your videos help me so much. A few months ago, I was suffering panic attacks daily from a traumatic health event I had suffered at the ER from hormonal issues (I was treated and am fine now). Whenever I would watch one of your videos during a panic attack, my heart rate would start to slow down and I would feel calm again. Thank you for all you do for us”
“I had 174/100 at the ER when I was there for extreme stomach pain. The doctor didn’t think it was dangerously high (?!). Having a bad cold now my BP at home is 143/89.
It’s not high in the morning and it goes down to 112/70 most nights. I’m vegan, not overweight, no diabetes never touched alcohol. Haven’t exercised for weeks now. Because of stomach pain and now a bad cold with fever. My husband used to have high BP. He took medicine for it. He started to run, eat healthy now his BP is 125/70. No more medicine for him.”
“This is so good! I went to the doctor in 1999 for a cough. My BP was high and I was put on RX. Never asked what I ate or did for exercise. When the new BP guidelines came out she doubled my dose. My now former doctor insisted on changing my BP RX because my BP was up at one appointment. I had brought readings showing my BP was good. I gave her a [piece] of my mind and walked out.”
“I’m 28 years old with White Coat Syndrome and when I’m severely anxious my readings have been anywhere at 144 to 150. When I calm down my readings are at 125. It’s crazy because most of the time the medical professional is always trying to tell me I have high BP, which makes me even more anxious. I’ve only had one person tell me that it’s from anxiety, but it was because they took multiple readings and noticed that my BP was fluctuating. They asked me if I was anxious and I said yes. Gave me a BP medication tablet and waited a while for the next reading, it was low, waited again for the next reading…it was high again. She said okay, this is definitely anxiety. Of [course], when I’m not anxious readings have been normal in the past”
“I have been studying this for YEARS and you are the very first doctor that can really “sort” the whole process for me! I have had “higher” blood pressure(average 145/70) with some freak high numbers of 160/90 and some very LOW readings of 120/70. Whitecoat syndrome has been a problem for years because every doc I see freaks out about my number. I anticipate this and immediately am higher. This always goes down after leaving their office. I did do meds, had terrible side effects, and have since abandoned them. My other risk factors are virtually zero and the doctors admit that but still pressure me to take meds. I now have printed the study you gave in another video to take with me about the NNT–THANK YOU SO MUCH! You have NO idea how relieved I feel after listening to you!”
Conclusion
The current hypertension guidelines encourage accurate measures and treatment of blood pressure. Based on the guidelines and current research, traditional office blood pressure monitoring should be abolished. Automated office blood pressure monitoring should replace it, using home blood pressure monitoring for accurate blood pressure diagnoses and treatment.
Resources
Roerecke M, Kaczorowski J, Myers MG. Comparing Automated Office Blood Pressure Readings With Other Methods of Blood Pressure Measurement for Identifying Patients With Possible Hypertension: A Systematic Review and Meta-analysis. JAMA Intern Med. 2019;179(3):351–362. doi:10.1001/jamainternmed.2018.6551
Gupta, S. High Blood pressure and the White Coat Syndrom. Retrieved from https://www.youtube.com/watch?v=pfoun7Q_BWA
AHA AMA https://www.youtube.com/watch?v=vJ1Y-sDW7-I
