PRESCRIPTIONS
'White-coat hypertension' needs attention

By Landis Lum

Q.My doctor wants to start both me and my husband on blood-pressure pills, and his blood pressure is only 145/95. And my blood pressure is fine at home and only high in my doctor's office — isn't this just "white-coat hypertension"? We don't have headaches, tiredness, dizziness or anything.

If you don't treat your hypertension early enough, you might develop memory problems, early Alzheimer's disease, kidney failure, and heart failure (leading to shortness of breath and fatigue). And recent results from the Framingham Heart Study shows that mild hypertension is worse than previously thought i if your blood pressure rises from less than 120/80 to a "high normal" level of 130 to 139 for your systolic or upper-number pressure (or 85 to 89 for your diastolic or lower-number pressure), then during the next 10 years, your chances of a heart attack, stroke, heart failure or sudden death double.

For instance, the journal Lancet reported a study of more than 420,000 people which showed that your chance of a stroke doubles when your diastolic pressure increases from 76 to "only" 85. And recent data indicates that systolic blood pressure may be more important than diastolic blood pressure.

A study by Dr. Anna Grandi and others reported in Archives of Internal Med in December 2001 found that patients with high blood pressure in their doctors' offices but normal blood pressure at home had increased heart- wall thickness and abnormal stiffness of their hearts. "White-coat hypertension" can damage your heart. It's likely that if your pressure is high in your doctor's office, it's also high at other times of the day whenever you get stressed. In an editorial, hypertension expert Dr. Marvin Moser concluded: "At present, with our knowledge of the benefits of lowering blood pressure and the realization that this usually does not involve complicated or dangerous regimens, it is good policy to treat white-coat hypertensives."

And even though blood pressure normally gets higher with age, this doesn't mean this is safe. In fact, the latest national guidelines makes a recommendation that many physicians don't realize: "The goal of treatment in older patients should be the same as in younger patients (Translation: get blood pressures to below 140/90 if at all possible)."

So yes — try lowering your blood pressure naturally: eat four servings a day of both fruits and vegetables along with two servings of 1-percent or nonfat milk or yogurt, eat less meats and salty foods, lose weight, avoid excess alcohol and exercise more. But if your blood pressure remains high, don't wait too long before starting drugs.

Dr. Landis Lum is a family practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine.

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