White coat hypertension, high BP, omron blood pressure monitor. Reading varies?

Posted on Tue, 2 Oct 2012 in Hypertension and Heart Disease
Question: I consistently get higher BP readings (150/100) at the doctor's office; but if i measure at home using the Omron blood pressure monitor, the average reading is around 119/72. I was told that it could be due to white coat hypertension. But my question is that can it vary so much between home and doctor's office
BTW, i have done the following tests:

- Creatinine serum (0.8)
- Electrolytes Sodium (135.1)
- Electrolytes Potassium (4.28)
- Urine analysis (Normal)
- ECG normal
- ECHO normal except for concentric LVH
- Kidney scan normal and no hemodynamic significant narrowing/occulsion of main renal arteries
Answered by Dr. Raja Sekhar Varma 15 hours later
Hello ,
Thank you for your query.

Before diagnosing white coat hypertension, I would advise you to calibrate your Omron BP monitor against a standard mercury sphygmomanometer. This is necessary to ensure the accuracy of the readings taken by the electronic device.

It appears that you are a hypertensive patient taking two drugs for BP control. The concentric left ventricular hypertrophy is a response of the cardiac muscle to sustained high blood pressures. Just as your biceps and other muscles become bigger when you do weight training in a gym, your heart muscle also becomes thicker when it has to pump against a consistently high BP. Thus, LVH(left ventricular hypertrophy) is a sign that there is some strain on the heart in the form of elevated BP.

The other blood reports, ECG and renal doppler are all normal.

White coat hypertension usually results in increase in the systolic BP (that is the upper reading), and not so much the diastolic BP (the lower reading). Hence, it is unlikely that the difference that you see is due to white coat hypertension per se. In addition to the calibration of the BP device, you should also take some precautions and use a correct technique while measuring BP.

1. Ensure the cuff is of proper size and is applied firmly to the arm.
2. You should have been at rest for at least 15 minutes before BP measurement
3. No tea/coffee/any other stimulant for 30 minutes before BP measurement
4. Measure BP in both arms, and at different times during the day.
5. Your arm should be supported against a table or arm-rest of the chair, while your BP is measured in the seating position.
6. Ensure a gap of at least 2-3 minutes before consecutive BP measurements.

I hope this answers your query. Feel free to contact me for any further clarifications.

With regards,
Dr RS Varma
Above answer was peer-reviewed by : Dr. Radhika
Follow up: Dr. Raja Sekhar Varma 34 minutes later
Dear Doctor,

Thanks for your elaborate response.

I have been checking my blood pressure with an ayurvedic physician near my house (using the mercury sphygmomanometer) and the readings I have recorded is in the range of 124/84 to 130/90. I have been checking my blood pressure for the past 4 weeks regularly at the same time of the day. But as I mentioned in my earlier query, I record a different blood pressure when I go to my primary doctor.

Regarding the cuff size, I have measured the circumference of my arm and ensured that it is in the range for my home monitor.

I'm really concerned about the difference in the mercury based meters as well now.
In addition, I would like one more clarification. If I maintain my blood pressure to be in the normal range along with exercise and diet restrictions, is it possible to reverse the LVH in the future?
Answered by Dr. Raja Sekhar Varma 8 hours later
Thank you for your reply.

I would like to know at what times were the pressures checked? Were the home recordings and the recordings done by your neighbour done at a different time from the clinic recording?

It is possible that the effect of the drugs that you are taking may be wearing off at the time of your clinic BP recording. Of course, this wont hold true if there are variations in BP are occurring despite measurement at similar times. You could then cross-check the accuracy of the recordings by measurement of the BP at another centre by a qualified physician.

I would still request you to calibrate the electronic device. This can be easily done at any authorized service centre.

As regards the LVH, studies have shown that reversal of LVH is possible in many patients with good BP control. Losartan, which you are taking already, is one such drug which helps in the reversal of LVH. But, you should realize that this is a long-term process and you need to maintain the BP control 24 x 7 for a good result.

I would also suggest you to check your fasting blood sugar and fasting lipid profile.

I hope this answers your query. If you have any further doubts, you can always get back to me.
With regards,
Dr RS Varma
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Raja Sekhar Varma 11 hours later
Dear Doctor,

Thanks for your comments. I will reach out to the OMRON service center for calibration.

Also I wanted to update you on the other tests I have done yesterday:

- Fasting Sugar: 124
- Total Cholesterol: 200.8
- HDL: 37.7
- LDL: 157.7
- Triglyceride: 94
- Micral test: 6

Answered by Dr. Raja Sekhar Varma 5 hours later

Thank you for the update.

Fasting blood sugar value of 124 mg/dl puts it in the range of Impaired Fasting Glucose. While the one value is not sufficient for a diagnosis of Diabetes, it is still high enough to warrant a sugar free diet and daily exercise. Repeat testing should be done after 4 weeks. You can also do an oral Glucose Tolerance Test and HbA1c.

The fasting lipid profile also shows a borderline total cholesterol level, elevated LDL (bad cholesterol) and a low HDL (good cholesterol). It would be preferable to take a lipid lowering drugs belonging to group Statin like Rosuvastatin or Atorvastatin, after clearance from your treating doctor. You will need to take this for at least 3 months, after which you can check your fasting lipid profile again and titrate the dosage again.

In addition, you need to control your diet as well by reducing fatty and oily food, avoiding fried food, avoiding meat, consuming lot of vegetables, avoiding butter/ghee/cheese/curds. Also, a minimum of half an hour should be spent in walking.

I hope this clarifies your doubts. I wish you all the best for a healthy life.

With regards,
Dr RS Varma
Above answer was peer-reviewed by : Dr. Jyoti Patil
Follow up: Dr. Raja Sekhar Varma 1 hour later
Dear doctor,

Thanks for your responses. I will discuss with my doctor today.

Answered by Dr. Raja Sekhar Varma 16 hours later

Thank you for your feedback.

All the very best for a happy and healthy life. September 29th is being celebrated as World Heart Day. You can do your bit by spreading awareness about prevention of cardiovascular diseases.

Dr RS Varma
Above answer was peer-reviewed by : Dr. Radhika
Answered by
Dr. Raja Sekhar Varma

Cardiologist, Interventional

Practicing since :1996

Answered : 192 Questions


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