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.
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)
|Understanding blood pressure readings (6)|
less than 120
less than 80
120 – 139
80 – 89
High Blood Pressure
140 – 159
90 – 99
High Blood Pressure
160 or higher
100 or higher
Higher than 180
Higher than 110
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.