Sunday, March 27, 2011

Hypertension: Only Home Readings Count! Do Not Start Meds Based on Office Readings.

One of the most determined focuses in medicine today is the need to control blood pressure.  If I preface my taking of the readings with a short discussion of stroke risk, I can be sure to provide my patient with transient hypertension.  Once one elevated pressure is recorded, the patient is likely to experience anxiety about future readings and I am likely to be able to "confirm" the patient has hypertension in the office. 

Internationally this situation is recognized as "white coat syndrome."  Andrew Weil has a nice piece on the current state of the literature:  At this point if you are not doing home blood pressure readings, then you aren't getting the care you need.  I say this because I have patients who's home blood pressure is dropping too low, and others whose blood pressure is controlled only sometimes. 

The aggressive treatment of hypertension is focused on preventing stroke, but we haven't been terribly effective.  I suspect part of the cause is that we aren't effectively controlling blood pressure for many individuals.  Home readings done over weeks often spike when home stresses increase despite all the medications.  The body accommodates to the medication, and overrides it. 

The underlying cause is the stress of life, and we need to focus more on helping individuals deal with those stresses.  Once the stress is past, we need to help patients "re-set" to lower blood pressure.

For the studies on hypertension, have a look at the literature at:

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