Man taking blood pressure at home.
(cglade, iStockphoto)

Some people go to the doctor and find the intake so
nerve-wracking their blood pressure spikes. Others find the
routine relaxing, as they’re asked to rest for a moment and
breathe easy before a blood pressure cuff is wrapped around
their arm.

People with borderline hypertension in both categories
should confirm the readings by measuring their blood
pressure outside their health care provider’s office, according
to new research published Monday in the American Heart
Association journal Hypertension.

Nearly 93% of U.S. adults who have high blood pressure
when measured in their doctor’s office and don’t take blood
pressure medicine meet the criteria for “white coat
hypertension” because their blood pressure is in an
acceptable range when re-measured outside a medical
setting. Meanwhile, about a third of U.S. adults experience
“masked hypertension” because their blood pressure levels
measured outside of the doctor’s office are more problematic
than measurements at the doctor’s office.

“For some people, a doctor’s office is a place they’re
relaxed,” said Paul Muntner, an epidemiologist at the
University of Alabama at Birmingham and the study’s senior
author. “They are away from job stress, traffic and family
issues.”

Others, he said, get anxious they are about to get bad
news about their blood pressure – or something
worse. Their readings in the doctor’s office cause concern
whereas measuring in a more familiar setting would cause
less stress.

In either case, the study used the American College of Cardiology and American Heart Association guidelines to determine that as many
as 104 million Americans routinely should use a blood
pressure machine at home to provide backup for – or a
contrast with – the results from their visit to the
doctor’s office. People are considered to have high blood
pressure if their systolic, or top number, is 130 or higher and
their diastolic, or bottom number, is 80 or higher.

Infographic: How to get your blood pressure checked

Measuring blood pressure outside of a
medical setting doesn’t have to be expensive or difficult.

Many pharmacies or grocery stores have blood pressure
machines customers can use for free. Reliable home versions
with an electronic inflatable cuff can be found at local drug
stores for less than $50, and Muntner said the device should
be one that already has been tested and validated.

Other options, such as ambulatory blood pressure
machines, can be more involved. Those provide readings
throughout the day and night and can flag hypertension while
people are asleep.

But the sheer size of the population the study suggests
should be measuring their blood pressure at home could
make it a daunting task to achieve, said Dr. Raymond R.
Townsend, who was not associated with the study.

“How many people would be well served by out-of-office
blood pressure monitoring? My answer would be virtually
anybody,” said Townsend, who heads up the high blood
pressure program at the Hospital of the University of
Pennsylvania in Philadelphia. “I think that’s a little
ambitious.”

The study concedes there are barriers to widespread
blood pressure monitoring at home: patient compliance,
accuracy of the results, out-of-pocket costs of the device and
the time needed to instruct patients on how to take their
blood pressure.

What is not subject to debate is the importance of
controlling hypertension. The consequences of unmanaged
high blood pressure can include heart disease, stroke and
organ damage.

And, Muntner said, the study makes a case that there is a
benefit to getting more people to check their blood pressure
on their own.

“For individual patients, hopefully it means people will
be more engaged with their own health care and not just
when they go to the doctor’s office.”

If you have questions or comments about this story,
please email 
editor@heart.org.

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