August 1, 2011
Last night, I had the pleasure of dining with Wayne Bell, MD, my friend and one of the best physician/educators I know. Dr. Bell was in Chicago learning about new advances in the treatment of diabetes and sharing his expertise with Renee and me. As physician/educators, it is our job to seek new knowledge; and when Wayne and I are together, the conversation always centers on some controversial aspect of medicine.
Last night, we spent a little time debating the existence of “White coat Hypertension” (WCH). Personally, I don’t believe in WCH. If being seen in your doc’s office is enough to raise your blood pressure (BP) into unacceptable ranges, then what happens when the boss calls you into her office on short notice. What happens when you are in the “10 items or less aisle” and the woman in front of you has 22 items and 14 coupons (I counted them? At 22 items, my pressure went up 10 points. When the coupons came out of the purse, I entered stroke territory.)
There are lots of stressful situations that rival going to the doc’s office. The only difference between going to the doc’s office and being in your supervisor’s office may be that your doc takes your pressure. I know, your BP is fine when you take it at home every morning. You can’t have hypertension! I hear that argument all the time.
The vast majority of studies on the effects of hypertension and its treatment are done on “in-office” blood pressures. Experience tells me that normal home blood pressure is lower than office blood pressure (unless you live with a shrew). Yes, there probably are different “norms” based on life’s stresses and 120/80 is the norm for office BP.
If you are worried about WCH, there are several things you can do to help you achieve a better in-office BP:
- Ask to have your BP done after sitting, feet on the floor, in a chair for 3-5 minutes.
- Relax! Take a few deep cleansing breaths.
- Don’t load up on caffeine and other stimulants.
If you can’t relax, you’ve got a problem. It’s time to learn some form of meditation.
These three easy steps my help lower your blood pressure significantly. The trick is telling the boss that you want to sit in her office for 3-5 minutes, in silence, feet on the floor, breathing deep, before she berates you!
While there probably are a few patients with WCH, the vast majority of patients who have elevated BP in their docs’ offices have hypertension. Remember, the treatment of hypertension includes life style changes, the “DASH” diet (http://livewellthy.org/2011/03/23/dash-diet.aspx), exercise, meditation, and medicine.
My patients always try to sell me on giving them a chance to change their habits before starting medications. “Doc, give me three months! I’ll take off 20 pounds, cut back on salt and fats (while thinking he can buy low fat, low salt bacon), and bring my pressure down the all natural way.” Thirty years in practice has made me a cynic.
Here’s my advice. If you have hypertension, start on medication and get your pressure under control. Work hard on lifestyle changes, diet, and exercise. Learn meditation and how to cope with your boss (there is no coping with the moron who can’t count to 10). When your pressures are good and your lifestyle is healthy, your doc can try weaning you off your medications. Living a healthy, medication-free lifestyle will be your reward for doing the right thing.