High blood pressure is often overlooked
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More about the experts All content is checked by medical journalists.Even if the doctor measures normal blood pressure values, the patient may have high blood pressure. This is only discovered during a 24-hour measurement. The false all-clear particularly affects people who actually do not look like risk candidates, namely slim, young and otherwise healthy people.
For some people with normal blood pressure, the excitement at the doctor's office makes the levels skyrocket. Doctors then speak of white coat hypertension. But this is much rarer than the reverse: the measurement in the doctor's office falsely gives the all-clear. A subsequent 24-hour measurement shows that the blood pressure is actually too high. At least that is what the results of Joseph Schwartz and his team from Stony Brook University suggest.
Incorrect measurements at the doctor
The doctors measured the blood pressure in 888 younger, healthy patients with an average age of 45 years in two ways: on the one hand at three appointments in the doctor's office with three repetitions each, on the other hand as part of an outpatient 24-hour measurement in their own four walls . The patient wears the measuring device and blood pressure cuff on their body for 24 hours.
The surprising thing: The 24-hour recording showed on average higher values than the practice measurement: 123/77 mmHg (millimeters of mercury) compared to 116/75 mm Hg. The 24-hour value exceeded that in more than a third of the participants measured by the doctor even by more than 10 mmHg.
Overlooked high blood pressure in every sixth person
In practice, the doctors had overlooked high blood pressure in 15.7 percent of the test persons, which was only then revealed by the 24-hour measurement. For comparison: white coat hypertension only occurred in one percent of cases.
The false-low values mainly affected younger, normal-weight people. With increasing age and BMI (body mass index), the difference between the practice measurement and the measurement in your own four walls decreased.
24-hour measurement from 130 mmHg
The scientists are still speculating about the exact causes of their results. What is known, however, is that blood pressure fluctuates over the course of the day, so that a point measurement is less able to capture the average value than a 24-hour measurement.
The risk of high blood pressure being overlooked is particularly high if a pressure in the higher normal range was measured in the doctor's office: In test subjects with an ideal practice pressure of 120 mmHg, the long-term measurement revealed high blood pressure in only ten percent of the cases. If the value determined by the doctor was already above 135 mmHg, half of the participants had hidden high blood pressure.
"For younger, slim people with a practice blood pressure in the upper range (130-139 / 85-89 mmHg), an outpatient 24-hour measurement could be useful," writes scientist Bryan Williams in an editorial accompanying the study.
Silent killer
Because although high blood pressure does not cause any symptoms for a long time, it is considered a "silent killer". In the long run, it damages the blood vessels and can lead to heart failure or a stroke, for example.
Blood pressure values that are too high are common - in around half of Germans the pressure in the blood vessels exceeds normal values.
Sources:
Schwartz J.E. et al .: Clinic blood pressure underestimates ambulatory blood pressure in an untreated employer-based US population, Circulation, 2016; 134: 1794-1807.
Willams B. et al .: Time to Abandon Clinic Blood Pressure for the Diagnosis of Hypertension ?, Circulation. 2016; 134: 1808-1811.
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