“White coat” or “hidden” high blood pressure? Between the two, our arteries sway… A painful observation for doctors, but with self-measurement, the student surpasses the master.
The first phenomenon is well known: for fear of the sanction, in one out of three patients, the two figures of blood pressure tend to fly away. The tribute to be paid to anxiety. This is the famous “white coat” effect, which leads some to be put on treatment when they absolutely do not need it.
On the other hand, a study published by Pr Christophe Tzourio, director of an Inserm unit in Bordeaux, a few years ago, worried the medical profession. According to the results, some patients are only hypertensive outside of their doctor’s office. With much more dramatic consequences: reassured, the patient does not treat himself or stops his treatment.
Masked hypertension
It then becomes a real target of hypertensive disease, ultimately responsible for disasters such as infarction, stroke, to mention only the best known. If a few lucky ones discover lower figures than at their doctor’s, the Inserm study revealed that masked arterial hypertension, that’s its name, was also very common: for some unknown reason, 40% of participants who had normal blood pressure at the testing center had high blood pressure at home. Admittedly, these were people over 73, but we also know that serious accidents are more frequent after this age.
This study was made possible by the generalization of self-measurement, ie the ability to take blood pressure at home. Doctors have long been opposed to this loss of power of the most symbolic examination of their consultation, citing the consequences of fear and overmedicalization. This is no longer the case: they almost systematically offer their patients to buy a device that is not subject to any emotion!
The sick better doctors than the doctors themselves
The measurement of blood pressure by oneself, thanks to self-measuring devices, would be more reliable than that carried out in the doctor’s office. It is this conclusion, to say the least surprising, that the very serious review JAMA publishes following a study conducted by French cardiologists. In a word, would the sick have become good doctors?
This work was interested in real hypertensives, that is to say with a tension that exceeds 14 for the maximum and 9 for the minimum. We know that high blood pressure silently exposes you to serious complications such as strokes, heart attacks, or worse, death. A silent killer because for years the hypertensive does not feel sick, the only manifestations being the blood pressure numbers.
The 5,000 hypertensives in the study are well monitored medically. At the beginning of the experiment, they take their blood pressure alone at home with these famous automatic devices, 3 times in the morning and 3 times in the evening for 4 days. Then follow-up visit to the doctor.
1 in 10 people with abnormal digits
And the results are astonishing: in one out of 10 people, the self-measurement shows abnormal blood pressure figures while those recorded by the doctor are within normal limits. The latter therefore thinks that his measurement is the right one and does not modify the treatment of his patient. The problem is that the study shows that it is the latter who is right and that, subsequently, they are then as much exposed to the risk of hypertension as untreated people..
This confirms all the interest of these self-measurement devices. Especially since, on the other hand, there is another category of patients, those who are hypertensive only in the presence of the doctor: it is the famous white coat effect which is worth to some to be put under treatment then that they don’t need it. Nearly one in three people who are found to be hypertensive at the doctor’s office would be in this case.
A simple purchase in pharmacy
From 20 to 80 euros, depending on the model, but the measurement on the arm is much more reliable than that on the wrist. As for the one at your fingertips, it is often fanciful. “These results underline the importance of self-measurement in implementing measures to lower blood pressure. Self-measurement also makes it possible to strengthen the dialogue between patient and doctor and to better adapt the treatment”, concludes Professor Christophe Tzourio.
Two numbers to characterize the tension: the first, the highest, is the maximum pressure when the heart contracts and propels blood through the arteries; the second, the lowest, corresponds to the minimum blood pressure when the heart relaxes. The doctor speaks in millimeters of mercury, for example 130/80mmHg, but the language of the general public rather retains 13/8 which are the numbers of normality.
Studies have shown that bringing the blood pressure below the magic number of 14 halves the number of strokes and heart attacks, and that there is indisputably an effect on arteritis and atherosclerosis in general. In this disease, the figures are not very to the honor of our doctors: because if there are 14 million hypertensives in our country, 4 million are unaware of it. Monitoring one’s own blood pressure also has another advantage: it would promote good follow-up of the treatment, because the disease does not have many symptoms and medication is too often forgotten.
.
