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Is mHealth Monitoring for Hypertension Safer Than the Doctor’s Office?

A recent study of so-called 'white coat hypertension' finds that blood pressure readings taken at the doctor's office can be less accurate and more dangerous than readings taken at home with mHealth devices.

Source: ThinkStock

By Eric Wicklund

- New research suggests that using mHealth to monitor blood pressure may actually be more accurate and safer than blood pressure readings taken in a doctor’s office.

A study recently published in the New England Journal of Medicine finds that “white coat hypertension” or “white coat syndrome”– elevated blood pressure caused by being in a doctor’s office – can double one’s risk of death, compared to those whose blood pressure is normal. And it reportedly affects as much as 30 percent of the US population.

“White-coat hypertension is not benign," Dr. Haitham Ahmed, medical director of cardiac rehabilitation at the Cleveland Clinic, who was not a part of the study, told NBC News. "If seeing a white coat increases your blood pressure, a lot of other stressors in life are expected to as well.”

The results suggest that telehealth and remote patient monitoring programs that capture blood pressure readings at home not only produce a more accurate cardiovascular history, but they can also improve clinical outcomes by reducing stress.

The ten-year study of some 64,000 people in Spain, conducted by researchers at the Autonomous University of Madrid, found that blood pressure readings taken at home with mHealth devices were 50 percent more accurate than readings taken at the doctor’s office.  

In addition, roughly 10 percent of those involved in the study showed elevated blood pressure readings when measured in the doctor’s office, the study found, yet exhibited normal readings when measured at home. Conversely, almost 4 percent exhibited normal readings in the doctor’s office, yet were found to have dangerously high blood pressure when monitored at home for 24 hours.

“White-coat hypertension was not benign,” the study concluded, “and masked hypertension was associated with a greater risk of death than sustained hypertension.”

"We don't want to dismiss white coat hypertension," Dr. Raymond Townsend, director of the hypertension program at Penn Medicine and author of a commentary accompanying the NEJM study, told NBC News. "We encourage our patients to do blood pressure readings at home. That is a good way to not only monitor blood pressure where you actually ‘live,’ but it also provides a lot of insight for patients to understand how life's little indiscretions, like take-out Chinese with extra soy sauce, can truly affect your blood pressure the next day."

Townsend further noted that research undertaken by the Agency for Healthcare Research and Quality (AHRQ) has found that ambulatory blood pressure monitoring “should be the reference standard” for identifying high blood pressure.

“This research is a clear game-changer,” Professor Bryan Williams, of University College London’s Institute of Cardiovascular Sciences, told the London Telegraph. “(F)or the first time, it definitively shows that blood pressure measured regularly during a 24 hour period predicts the risk of heart disease, stroke and death much better than blood pressure measured in a doctor’s surgery or clinic.”


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