Is your doc making your BP shoot up?

Okay, so I have high blood pressure (hypertension), so do one in every three adults worldwide, say World Health Organisation estimates. But unlike hypertension plaguing other unfortunate adults — unfortunate because it contributes to 62% strokes and 49% heart attacks — my hypertension has mood-swings. It doesn’t simply fluctuate, as I’ve been told is common enough, but shoots up faster than a pole-vaulter on steroids at the sight of a doctor.

There’s a name for this condition. It is called white-coat hypertension, a condition I first heard about five years ago when I aced my preventive health check-up except for the borderline hypertension reading that perplexed the doctor. Ten minutes later, a chatty nurse took my blood pressure and I got a perfect score of 120/80 mmHg. This very weird condition makes blood pressure shoot up when it is being measured by a doctor, who traditionally wears a white coat. When measured in settings other than a hospital or clinic, such as home, the pressure drops to normal.

I totally get this, I’m perfectly normal when I meet doctors for work, but when I meet them for treatment, I mentally freak out. It’s probably because writing on health is a bit like reading the medical almanac that carries the risk of turning borderline worriers into certifiable hypochondriacs.  But except for white-coatitis , I have no diagnosed health problems. Not yet anyway.

So when I mentioned my disorder to Dr RR Kasliwal, chairman of the division of clinical & preventive cardiology at Medanta, he laughed and insisted on measuring my blood pressure. He was in a white coat and blue crocs, so my blood pressure rebelled and shot up to an incredible heart attack-inducing 180/110 mmHg. Clearly, blue crocs don’t have a calming effect on nervous patients.

Dr Kasliwal immediately insisted on strapping an ambulatory blood pressure-monitoring machine to my arm to track my blood pressure over the next 24 hours, even as I slept. Ambulatory monitoring would record whether my blood pressure was in the normal range as I went about my day.

So I had a cuff strapped to my left arm and a small but chunky cellphone-sized gadget swung under my clothes — I pulled out my baggiest shirt for this experiment — and went off to work. Ambulatory tracking involves blood pressure checks every 30 minutes during the day and every hour during the night, so I took the precaution of warning my colleagues about it. I’m glad I did because every half hour, the machine would suddenly whirr and inflate the arm cuff, which is a bit embarrassing in quiet surroundings. I got through okay because newspaper offices are anything but quiet.

The ambulatory tracking showed that my high blood pressure was “reactionary” and was normal while I slept — also normal after two wines — so I’m in a good place.  Almost one in three hypertensives actually have white-coat hypertension, with only about 63% people having resistant hypertension, where the blood pressure remains high irrespective of the surroundings, reported a Spanish study in the journal Hypertension last year. It also found more women had the problem: 42 % women compared to 34% men.

Ambulatory monitoring helps lower medicine dose in one in four hypertensives, found a study by Dr Kasliwal and Dr Manish Bansel in the Journal of Clinical and Preventive Cardiology in July this year. Their study of 158 hypertensives on medicines showed that people with controlled blood pressure had lower readings on ambulatory monitoring as compared to those with uncontrolled hypertension.

For me, the high point of the day was lunch out, where I went through the usual hotel metal detector and a physical frisking for hidden weapons and explosive devices. The guard bought my explanation of the whirring and wired gadget being a medical device without batting an eyelid, which showed that either the hotel guards are for display only or that ambulatory devices are more common than I believed. I did not want to find out.


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