Clinical Pearl Wednesday #88

Blood Pressure Blood Pressure  - MostafaElTurkey36 / Pixabay

White coat hypertension is a real phenomenon. You really should not be so “trigger happy” when it comes to prescribing antihypertensive medications to your patients.

Instead of basing your decision to treat the patient based off of in clinic readings, teach the patient how to take their blood pressure at home effectively.

I have my men’s health patients bring in their at home blood pressure machine and we compare it against our more expensive “clinic” one. After we determine what their blood pressure reading is, we ensure they know how to properly take their blood pressure. We then instruct the patient to check it daily at the same time for 2 weeks and keep a log. Often times, their blood pressure is 15-20 points lower than what is obtained in clinic secondary to the white coat phenomenon. My men’s health clinic is pretty relaxing and “chill”, yet some patients STILL have white coat phenomenon.

If the patients blood pressure readings are normal at home, then the patient does not need to be on hypertensives. I have seen dozens of patients over the last decade who complain of dizziness and fatigue secondary to being hypotensive from unneeded hypertensive medications.

4 Responses

  1. Just as pain can cause an elevation of blood pressure so can the effect of anxiety, fear, or mistrust. White coat hypertension is easily distinguishable using what Justin has illustrated above.

  2. I also don’t jump on the first number I see. I think we should be taking pressure mid visit rather than the beginning, especially when they’ve just rushed in trying to beat traffic.

    1. 100% agree… often times the BP drops 10-20 points after they have had time to just “relax.”

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