Home tests fight 'White Coat Syndrome'
Posted July 7, 2011
Durham, N.C. — The stress of visiting a doctor's office can throw off blood pressure measurements that determine what medications patients get, according to researchers at the Duke University and Veterans Affairs Medical Center in Durham.
John Goin, a 68-year-old Chatham County farmer, keeps close track of his blood pressure because of his family history with the disease that is a major cause of stroke, heart failure and kidney disease.
"My dad passed away at 54 years of age from extensive hypertension," he said.
Goin's daily routine includes measuring and recording his own blood pressure.
He discovered a significant difference between the numbers taken at his home and at his doctor's office.
"I'll look at numbers that are 10 to 15 points higher than what I had had at home before I left home," he said.
Those spikes in blood pressure at the doctor's office are called White Coat Syndrome. Doctors and patients had long suspected it, and recent work by Duke and VA researchers proves it.
"Even when it's measured properly, there's an impact of stress from being in a doctor's office," said Dr. Benjamin Powers, with the VA Medical Center in Durham.
Powers led a study of 444 patients comparing home tele-monitoring and clinic-only measurements. Decisions based on home measurements led to an almost 20 percent improved control of blood pressure.
"The evidence is actually shifting toward home measurement actually being a better predictor of those outcomes that are important for patients," Powers said.
May patients, including Goin, used equipment recommended by doctors in the study and learned how to use it properly.
"After every two weeks or so, my wife puts the results on (Microsoft) Excel and sends it to Dr. Powers," Goin said.
For long-term management, many changes to medications can be made without an office visit, Powers said.
Studies show that only half of people with hypertension are aware of it, and only half of those people have it well controlled. People should know their family history of heart or blood pressure problems and see their doctor regularly to catch those conditions early.