New blood pressure recommendations: White coat syndrome, masked hypertension, and more

Did you know blood pressure readings can be location dependent in some patients? Because of this, the USPSTF has released new blood pressure recommendations for treating the disease.

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New recommendations on blood pressure screening from the U.S. Preventive Services Task Force (USPSTF) propose that preceding any treatment for elevated blood pressure, readings taken in the physician’s office should be confirmed by a number of comparable readings from outside the clinic. The recommendations appeared online in the Annals of Internal Medicine on October 13, 2015. (1) This article will review the changes in the guidelines.

Hypertension is sometimes silent and can predispose individuals to comorbidities such as heart disease, stroke, and kidney diseases. It affects about 30% of the population. (2) It fluctuates during the day based on our activities and stress levels. Blood pressure readings are often elevated in a medical or dental office due to white coat syndrome, a type of location-dependent hypertension attributable to the stress of being in a healthcare facility. (3) Another type of location-dependent hypertension is masked hypertension, which is having lower blood pressure measurements at the doctor's office than at home. (4)

READ MORE | Are you taking blood pressure in your practice?

To get an accurate reading, it is suggested to use a validated home blood pressure monitor or a device called ambulatory blood pressure monitoring (ABPM). It’s a standard-looking automated blood pressure cuff that includes a monitor to record the data. The cuff inflates every 20 to 30 minutes for a 24-hour period, whatever you do, wherever you go, including sleeping! The next day, you drop the device back off at the clinic and the data is downloaded. The American Heart Association recommends an automatic, cuff-style, bicep (upper-arm) monitor. Wrist and finger monitors are not recommended because they yield less reliable readings. (5) The USPSTF recommends ambulatory blood pressure monitoring as the reference standard for confirming the diagnosis of hypertension, but also states that good-quality evidence proposes that confirmation of hypertension with HBPM (home blood pressure monitoring) may be acceptable. (1)

For a brochure for yourself and your patients, and other information, go to the American Heart Association (AHA) website. To understand what the numbers mean, visit this section of the AHA website.

Understanding blood pressure readings (6)

Blood Pressure
Category

Systolic
mm Hg (upper #)

Diastolic
mm Hg (lower #)

Normal

less than 120

and

less than 80

Prehypertension

120139

or

8089

High Blood Pressure
(Hypertension) Stage 1

140159

or

9099

High Blood Pressure
(Hypertension) Stage 2

160 or higher

or

100 or higher

Hypertensive Crisis
(Emergency care needed)

Higher than 180

or

Higher than 110

And lastly, there are guidelines for blood pressure in the dental office here and here. We should all be taking blood pressures in the office, especially prior to administration of local anesthesia.

References
1. Final Recommendation Statement. Hypertension in Adults: Screening and Home Monitoring. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/high-blood-pressure-in-adults-screening#Pod2. U.S. Preventive Services Task Force website. Accessed October 28, 2015.
2. Piper MA, Evans CV, Burda BU, et al. Screening for High Blood Pressure in Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 121. AHRQ Publication No. 13-05194-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2014.
3. How to Overcome “White Coat Syndrome”. Guide to Healthcare Management and Healthcare Administration. http://www.acehsa.org/how-to-overcome-white-coat-syndrome/. Published December 23, 2012. Accessed October 28, 2015.
4. Pickering TG, Davidson K, Gerin W, Schwartz JE. Masked hypertension. Hypertension. 2002;40:795-796.
5. Choosing a home blood pressure monitor. American Heart Association website. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/SymptomsDiagnosisMonitoringofHighBloodPressure/Choosing-a-Home-Blood-Pressure-Monitor_UCM_303322_Article.jsp#.Vifr5GsYwnc. Updated August 4, 2014. Accessed October 28, 2015.
6. Understanding blood pressure readings. American Heart Association website. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp#.VifvqmsYwnc. Updated August 4, 2014. Accessed October 28, 2015.

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