‘We need more staff’
White-coat hypertension is not a problem in patients whose blood pressure is well controlled, a sub-analysis of the ASCOT study reveals.
Researchers found there was no difference in BP measured at home or in the surgery in patients controlled to targets.
The study suggests there is no need to control for the white-coat effect, as some guidelines have suggested, when using home blood pressure monitoring in well-controlled patients.
Overall home BP readings were only slightly less than surgery readings, by 0.8/1.6-mmHg, delegates heard at the British Hypertension Society annual scientific meeting last week.
Study leader Dr Adrian Stanley, consultant in cardiovascular medicine at Leicester Royal Infirmary, said: ‘It has been quoted that 30 per cent of patients have white-coat hypertension. The bottom line is we don't have to worry about it in well-controlled hypertensives.'
The researchers, working at the department of cardiovascular sciences, University of Leicester, found evidence of both white-coat effects and masked hypertension at extreme ends on the BP spectrum.
In patients with the highest office BP, averaging 158.8/84.4-mmHg, home readings were 13/5mmHg lower.
But those with the lowest office BP, averaging 117.7/69.5-mmHg, had home BP readings that were 9/1mmHg higher.
‘We've shown it isn't uniform across levels of blood pressure,' said Dr Stanley.
But he said GPs could be ‘reassured' by the overall similarity of home and office BP readings, and that home monitoring was a highly effective way of managing hypertension.
Dr Peter McCartney, a GP in Bristol and member of the Government's Committee on Blood Pressure Monitoring in Clinical Practice, said: ‘Home monitoring is certainly becoming more common but since all the cardiovascular endpoint studies use office blood pressure measurements, I would be reluctant to rely too heavily on home readings. More research is obviously needed.'