The blood pressure is fickle

We typically think of the blood pressure as a pair of numbers that are measured in the doctor’s office once in a while.  If the numbers are persistently too high, you have “high blood pressure” (also known as hypertension) and that’s a concern for the future.  If untreated, hypertension can lead to serious complications, including heart, kidney and brain damage.

But we know that people can get a little nervous when they’re at the doctor’s office, so the blood pressure may be high there but be normal the rest of the time.  That is called “white coat hypertension,” because the stress of seeing a doctor in a white coat is enough to raise the blood pressure!

And we also know that the opposite can occur: the blood pressure may be deceptively low at he doctor’s office, but much higher during the day when the stress of work or of taking care of the household is in full force.  That is called “masked hypertension,” because the doctor only sees normal blood pressure numbers in the clinic and is unaware that the numbers are actually higher most of the time.

The blood pressure changes all the time, so it’s quite challenging to make a determination about hypertension on a few sets of numbers taken here and there.

A new way to measure BP

A few years ago, medical device manufacturers developed ambulatory blood pressure monitors (ABPMs), which are simple blood pressure machines, the size of a WalkMan tape player (does anyone remember those?!).

The device can be worn over a period of 24 to 48 hours and which automatically obtain a large number of measurements while you’re out and about during the day, and even at night when you sleep!

The information obtained by the ABPMs can be extremely valuable.  A study just published in the New England Journal of Medicine shows that the ABPM can better predict future problems than clinic blood pressure measurements.  Furthermore, people with “white coat hypertension” as well as those with “masked hypertension” have a higher risk of future complications compared to people whose blood pressure is normal on a 24-hour ABPM.

At Athletic Heart SF, we’ve used the ABPM as part of our diagnostic battery of tests for many years.  In fact, we may be one of the few—or perhaps even the only—clinic in the SF Bay Area that offers ambulatory blood pressure monitoring.

Is this the right test for you?

Now, the question is: Who should have their blood pressure checked by ABPM?

There is no standard criterion that is widely accepted to answer that question.  Clearly, if your blood pressure is routinely very normal at the doctor’s office and there are no concerns, you may not need to be checked further.  Also, if your blood pressure is clearly very high in the office, chances are it is high at other times too.

On the other hand, anyone who has a “borderline” high blood pressure or “white coat hypertension” may benefit from having readings obtained with an ABPM.  Likewise for people whose blood pressure is highly variable or who are prone to stress and who have reason to believe that the blood pressure in the doctor’s office may be deceptively low.  Such persons may have “masked hypertension.”

If in doubt, check with your physician and ask them about ambulatory blood pressure monitoring.  If you live in the SF Bay Area, your doctor could send us an order and we’d be happy to get you set up.  Alternatively, feel free to call us directly for a hypertension consultation that can also include placement of an ABPM, if appropriate.

I hope you have found this article informative and look forward to sharing more information with you about cardiovascular health in future articles.

–Dr. Accad

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