Just because there’s a name for it doesn’t make it harmless. There’s a study from the Autonomous University of Madrid that followed 64,000 people over 5 years and found that the risk of death was twice as high for people with white coat hypertension.
Fair enough. But for every month of anti-hypertensive therapy (this was for isolated systolic hypertension) a person gains an average of about 0.59 days of life expectancy.
That means after 22 years of therapy for hypertension you gain about 4-5 months of life expectancy.
I’m not criticizing that, but that means the life expectancy gap between treated and untreated hypertensives is generally less than a year.
Meanwhile the life expectancy gap between black men and latino women is 12 years. Black men are at about 71, latino women are 83.
The life expectancy gap between the top income decile and lowest income decile can be as big as 20 years. In some areas the rich live to their late 80s while the poor live to their early 70s at best.
Life expectancy gap between college graduates and high school graduates is about 10 years. Generally mid 80s vs mid 70s.
As someone who suffers from severe white coat hypertension (my normal blood pressure is not bad, but when I have anxiety it shoots to 210/120) to the point where I generally avoid visiting medical professionals because of it (part of it is that I’m scared a doctor will call an ambulance without my consent and I’ll get a $3000+ bill for medical care I don’t want and didn’t request), I am perfectly comfortable with the 5-11 month hit to my life expectancy due to my hypertension. I just wish doctors would leave me alone about it and quit acting like I"m about to die. Statistically, they’d be better off having a panic attack every time they saw a black person or a person who didn’t complete college because being black or not going to college causes far more loss of life expectancy than hypertension does.
Let me know Wesley when there is something fairly cheap and easy and generally well tolerated that a doc can do during an office visit that will address the impact of being Black or non-college educated on life expectancy. We look for things we can do something about.
I’d also be interested in QALY - treatment of hypertension reduces other disease burden, such as the risk of heart failure. Living longer is often less important that living the years we have better and disability free.
Here’s the thing though - the initial approach to most identified as having elevated blood pressure should be improved nutrition and regular exercise … but that should be done for normotensives too. My question is what does labelling the population gain? ARE they more likely to engage in life style changes by virtue of the label?
That’s the problem with using averages for things like this. The average person doesn’t gain 4-5 months after 22 years. The average person gains nothing because they die from something unrelated to hypertension. One person in 20 might gain 10 years because treatment staves of a heart attack or a stroke. If you’re that one person; bonus. As long as the treatment of the other 19 doesn’t cost too much in side effects or money it makes sense to treat all 20.
Averages applied to a population say nothing about what will happen to an individual. If you want to use this as a basis for your decisions, you’ll want to make sure your facts are in order.
Lots of medicines are considered good if they prevent a heart attack in one in twenty people who take them. Increasing a life length by one percent is significant, especially if the quality of life is improved for many years.
I just don’t believe high school graduates die ten years sooner than college graduates. Please offer a cite. No doubt education, race, rurality and social determinants affect health. Diabetes, that could lessen your life by ten years.
The role of doctors is to offer you the best advice they can based on current understanding. No one is obliged to take this advice, but a more informed understanding of the situation is better than a less informed understanding. I rarely tell patients to wear their seat belts (and that would certainly be the deciding factor in your decision to buckle up, I’m sure)… but this also can be a major determinant of health and life quality.
The link between education and health is there… but is much confounded. A degree affects job prospects and income, likelihood of smoking or drug/alcohol addiction, access to health services and insurance, some lifestyle choices, exposure to crime and frequency of eating healthy meals… I have seen the 10 year difference quoted in PLOS based on years left at age 25, and a claimed 7 year mortality difference.
It has been claimed getting a high school degree later in life might mitigate these confounded and in prove mortality. I bet the effect is smaller than predicted.
It’d be nice to just tell a doctor I have white coat hypertension, tell them I accept the risks and have them leave me alone about it. That is all I ask.
I have multiple stories, but I once went to see a neurologist about a condition totally unrelated to my white coat hypertension. I told the nurse I didn’t want my BP taken. She insisted. I told her my readings would be high due to anxiety. When I got my readings (190/120 I think) the doctor wasted the entire session trying to convince me that anxiety takes 40-50 years off human life expectancy. That session cost me over $200 and we barely addressed the underlying health issues that caused me to visit the doctor in the first place. I have another story where I saw a doctor about a suspected slipped disc in my neck. She spent the entire session trying to convince me people die from anxiety, did nothing for my neck and charged me $200. The issue in my neck healed by itself in 6 months.
Point being, I wish I knew how to ask doctors politely to just leave me alone about the issue of my blood pressure. And the idea of being forced to pay for expensive, unnecessary medical care that I didn’t agree to because the doctor thinks anxiety is life threatening is terrifying to me, being a US citizen in an overpriced, broken health care system (if I were in Germany, Canada, the UK or some other civilized nation this issue wouldn’t bother me much). I have my anxiety issues under control, but if everytime I go to the doctors I have to worry they may sign me up for medical care I do not agree to, care that will costs many thousands of dollars and possibly not be covered by insurance (or not hit my deductible), I just avoid the doctor when I’m sick. It helps no one.
Okay. A fair cop. Docs should make sure to first and foremost address the reason the patient is there. Failure to do that is without question a fail.
Of course anxiety has lots to do with how we perceive pain and with a wide variety of what gets labelled as “soft neurologic symptoms” so verifying that an anxiety disorder is being adequately addressed may not be inappropriate before pursuing expensive imaging, other testing, or treatments that have potential harms.
As to how to politely ask … if you have multiple times of your BP being normal when checked outside of a doctor’s visit share that fact right off and state clearly that you want to spend the time of this visit addressing problem X. Happy to call with a follow up BP taken not in an office next week or to return for a nurse visit to recheck if need be.
“I have anxiety and white coat hypertension. Outside the clinic, I have had lower blood pressures of X, and other doctor X is monitoring it. I know the risks of high blood pressure and accept them. I am here today to discuss other issues, namely…”
Thank you both for your responses.
I have brought in my home sphygmomanometer to doctors offices which had readings of around 135/85 to show the doctor to let them know that it is just white coat hypertension and my readings at home aren’t bad. I just want them to leave me alone about it because I have other medical issues I’d like to address.
Having this condition makes it hard to visit a doctor to get medical care for various reasons.