A Doctor tension

In some people, blood pressure rises when they visit the doctor.How do they deal with it?

Published: Monday 30 November 1998

A GERMAN physician noticed an illness about 250 years ago, which he coined the phrase "the pulse of the doctor". Now, the same illness has got a new name: white coat hypertension. It refers to an increase in the pulse rate and blood pressure (BP) of a patient when he gets them diagnosed at a doctor's clinic, as compared to when he does at home, the work place or at play. This variation, some doctors say, occurs because patients are nervous and undergo stress when they are diagnosed in a clinic. The result: they are mistakenly prescribed drugs for hypertension which tend to have harmful effects on the health of the patient. Therefore, they argue, this variation should be ignored.

On the other hand, some doctors argue that those patients who suffer from this tendency will get high BP every time they are tense and under pressure. A doctors' clinic is only one of the many places where the patients can suffer from a rise in the BP, and thus the tendency should be taken seriously.

The debate has resulted in a strong disagreement about the interpretation and treatment of white coat hypertension. These differences could have significant impact on patients' self-image and their risks of suffering from heart ailments and kidney diseases. It must be mentioned that once a patient starts taking medication for the control Of BP, it is normally never stopped. It is extremely important that a patient is diagnosed correctly.

A recent study in Hypertension (Vol 31, No 1), published from the University of Padova, Italy, has suggested that people with white coat hypertension tend to have thicker heart muscles than people with normal BP. Cardiologists believe that thickened heart muscles lead to illnesses like arrhythmia (irregular heart beats), which has often been responsible for sudden deaths. Arrhythmia occurs because the thickening interferes with the electrical system of the heart that regulates the rhythmic contraction.

According to Gareth Beevers, president of the British Hypertension Society, there is still no consensus on how to treat patients suffering from white coat hypertension, but he does have a piece of advice: improve lifestyle factors. In other words, stop smoking, lose weight and start exercises.

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