'White - coat' Hypertension

“God made doctors because he cannot be present everywhere at the same time”, is the usual quip of most medical representatives when they meet doctors, especially on Doctor’s Day. This often sets me wondering, ‘Doctors make mistakes. Does God also make mistakes?” So, to prove my point, I’ll relate an interesting incident that has made me change my perspective on blood pressure and on understanding of the elusive problem. 

It was a bright, rather pleasant summer morning, when a gentle, well turned –out banker walker into my chamber. In measured words ( remember, he was a banker), he discussed how he had been on treatment for control of high blood pressure for almost three years. He took very little salt, went for walks religiously and led a saintly life as far as possible in today’s world. The only sore point was his office stress that, I felt, he was managing pretty well. Yet, his blood pressure refused to return to normal. It seemed to have got stuck at 150/90. the whole thing did not make sense. Here was an easy-going, affable person taking all the possible precautions and had no family history of hypertension. He was on regular medication, yet his blood pressure refused to reach normal. I told him to buy a digital blood pressure apparatus ( though I feel, these cause more harm than good). He was a meticulous person and he was back to me in a week’s time with a tabulated blood pressure monitoring of the previous week. I could not believe my eyes when I saw the figures on the paper. The domiciliary blood pressure readings were all in the range of 120/70. I checked his blood pressure in the clinic and the readings were still stuck at 150/90. we checked up his blood pressure on his machine in the clinic and this too showed the same reading. That meant his apparatus was okay. 

This scenario fitted into a new-found disease, called ‘white-coat’ hypertension. This is a medical condition ( not a disease really) in white the patient shows a higher reading at the clinic but at home reveals a very normal reading. Erroneously, the patient is described as hypertensive and his treatment is commenced. Every now and then, medicines are changed because the blood pressure recording remains high. The banker – gentleman is now off medication but still monitors his blood pressure regularly . he has since been allowed to have his regular cup of coffee that he really relishes. This event made me sit up and think, ‘ why shouldn’t we educate our patients about hypertension. Its causes and management?” Hence, this small book as a mark of respect to all the ‘white-coat’ hypertensives who have been advised by their well-meaning family physicians to keep consuming medicines for hypertension ( which in reality they don’t suffer from) and to all those good souls who carry the burden of being labeled as ‘high BP’ patients all their lives.