Blood pressure determination: elimination of the white coat
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Conventional versus automated measurement of blood pressure in primary care patients with systolic hypertension: randomised parallel design controlled trial
Blood pressure determination: elimination of the white coat
Dear editor,
the trial of Myers MG and colleagues (1) showed that blood pressure fell
when done with the automated sphygmomanometer when the patient was left
alone.
Hereby the authors mention the crucial factor of detection and elimination
of the 'white coat response' which reduces the number of patients who
receive unnecessary drug treatment.
For example in teaching-practices, where the presence of a student had a
significant pressor effect added to the possible 'white coat phenomenon'
already associated with blood pressure measurement by the doctor-trainer
(2), doctors should be very cautious to initiate or adjust
antihypertensive drug treatment when readings are obtained in the presence
of a trainee.
For this reason, the method of self-measurement at home two times in
the morning and two times in the evening for seven days is becoming a
standard procedure in the Belgian guideline on hypertension diagnosis and
treatment (3) and self-measurement with an automated device is not only
seen as 'a supplement'(4), or encouraged or discouraged (5) as in the
monographs mentioned in the article of Myers. Hereby, to let the patient
use an automated device of the GP with instruction-document to fill-in,
for one week with a little deposit, is a realistic option for self-
measurement at home for most patients. In this situation, it is
recommended that a the patient compares his automated device yearly with a
validated device of his/her GP.
1. Myers MG et al. Conventional versus automated measurement of blood
pressure in primary care patients with systolic hypertension: randomised
parallel design controlled trial BMJ 2011; 342:d286
2. Matthys J, De Meyere M, Mervielde I, Knottnerus A, Den Hond E,
Staessen J, De Maeseneer J. Influence of the presence of doctors-in-
training on the blood pressure of patients. A randomised controlled trial
in 22 teaching practices. J Hum Hypertens 2004;18:769-73.
4. Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, et
al. Recommendations for blood pressure measurement in humans and
experimental animals part 1: blood pressure measurement in humans--a
statement for professionals from the Subcommittee of Professional and
Public Education of theAmerican Heart Association Council on High Blood
Pressure Research. Hypertension 2005;45:142-61.
5. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano
G, et al. 2007 guidelines for the management of arterial hypertension: the
Task Force for the Management of Arterial Hypertension of the European
Society of Hypertension (ESH) and of the European Society of Cardiology
(ESC). J Hypertens 2007;25:1105-87.
Rapid Response:
Blood pressure determination: elimination of the white coat
Dear editor,
the trial of Myers MG and colleagues (1) showed that blood pressure fell
when done with the automated sphygmomanometer when the patient was left
alone.
Hereby the authors mention the crucial factor of detection and elimination
of the 'white coat response' which reduces the number of patients who
receive unnecessary drug treatment.
For example in teaching-practices, where the presence of a student had a
significant pressor effect added to the possible 'white coat phenomenon'
already associated with blood pressure measurement by the doctor-trainer
(2), doctors should be very cautious to initiate or adjust
antihypertensive drug treatment when readings are obtained in the presence
of a trainee.
For this reason, the method of self-measurement at home two times in
the morning and two times in the evening for seven days is becoming a
standard procedure in the Belgian guideline on hypertension diagnosis and
treatment (3) and self-measurement with an automated device is not only
seen as 'a supplement'(4), or encouraged or discouraged (5) as in the
monographs mentioned in the article of Myers. Hereby, to let the patient
use an automated device of the GP with instruction-document to fill-in,
for one week with a little deposit, is a realistic option for self-
measurement at home for most patients. In this situation, it is
recommended that a the patient compares his automated device yearly with a
validated device of his/her GP.
1. Myers MG et al. Conventional versus automated measurement of blood
pressure in primary care patients with systolic hypertension: randomised
parallel design controlled trial BMJ 2011; 342:d286
2. Matthys J, De Meyere M, Mervielde I, Knottnerus A, Den Hond E,
Staessen J, De Maeseneer J. Influence of the presence of doctors-in-
training on the blood pressure of patients. A randomised controlled trial
in 22 teaching practices. J Hum Hypertens 2004;18:769-73.
3.
http://www.domusmedica.be/kwaliteit/aanbevelingen/overzicht/hypertensie-
In Dutch.
4. Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, et
al. Recommendations for blood pressure measurement in humans and
experimental animals part 1: blood pressure measurement in humans--a
statement for professionals from the Subcommittee of Professional and
Public Education of theAmerican Heart Association Council on High Blood
Pressure Research. Hypertension 2005;45:142-61.
5. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano
G, et al. 2007 guidelines for the management of arterial hypertension: the
Task Force for the Management of Arterial Hypertension of the European
Society of Hypertension (ESH) and of the European Society of Cardiology
(ESC). J Hypertens 2007;25:1105-87.
Competing interests: No competing interests