Untreated white-coat hypertension increases risk of cardiac events and mortality

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(ACP Internist excerpts): Untreated white-coat hypertension, but not treated white-coat effect, was associated with an increased risk for cardiovascular events and all-cause mortality, according to a systematic review and meta-analysis published in June 11 by Annals of Internal Medicine.

Twenty-seven observational studies with at least three years of follow-up were included. They evaluated 25,786 participants with untreated white-coat hypertension or treated white coat effect and 38,487 participants with normal blood pressure followed for a mean of 3 to 19 years.

Compared with normotension, untreated white-coat hypertension was associated with an increased risk for cardiovascular events, all-cause mortality, and cardiovascular mortality. The risk of white-coat hypertension was attenuated in studies that included stroke in the definition of cardiovascular events. No significant association was found between treated white-coat effect and cardiovascular events, all-cause mortality or cardiovascular mortality.

The elevated risk associated with white-coat hypertension was particularly evident in studies that used ambulatory blood pressure monitoring (not home self-monitoring) and studies with at least five years of follow-up time. These findings suggest that individuals with isolated office hypertension who are not receiving antihypertensive treatment should be closely monitored, while individuals who are receiving antihypertensive treatment could be harmed by overly aggressive management. They added that out-of-office blood pressure monitoring is critical in the diagnosis and management of hypertension.

White coat effect is not associated with increased risk, and out-of-office monitoring seems warranted to prevent intensification of antihypertensive treatment. For adults not taking antihypertensive medication, the risk for CVD [cardiovascular disease] events and all-cause mortality is only moderately increased, and this risk is substantially lower than that associated with sustained hypertension. Therefore, out-of-office BP monitoring is useful for distinguishing between white coat hypertension and sustained hypertension among persons with high office BP.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Hypertension during pregnancy can be detrimental to mother and baby: HCFI

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Awareness must be raised on preventive measures during and after pregnancy

New Delhi, 17th May 2019: National studies show that prevalence of hypertension among the Indian urban middle-class men and women is 32% and 30%, respectively. Factors such as family history, age, gender, diabetes mellitus, kidney disease, obesity, alcohol consumption, smoking, physical inactivity, and stress increase the risk. Despite this, not many people are aware of the condition or do not take preventive measures at an early stage.

Research indicates that women with high blood pressure, especially during pregnancy, are at a two-fold risk of heart failure post-delivery. The need of the hour is to monitor women before discharge and after giving birth, through the postpartum period.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “Hypertension during pregnancy can be detrimental to both the mother and the baby. Women with high blood pressure can develop resistance in their blood vessels. This hampers the flow of blood throughout the body including the placenta and uterus leading to problems with fetal growth. It can also cause premature detachment of the placenta from the uterus, disruption in the flow of oxygen to the placenta leading to delayed fetal growth, or in worst cases even stillbirth. If not closely monitored before, during, and after childbirth, it may become a major cause of heart problems including heart failure in such women. Some other fatal repercussions of high blood pressure include pre-term birth, seizures, or even death of the mother and the baby.”

Heart failure, or peripartum cardiomyopathy, can occur up to five months after giving birth. Some symptoms of this condition include tiredness, shortness of breath, swollen ankles, swollen neck veins and feeling of missed heartbeats or palpitations.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “It is imperative for women diagnosed with hypertension to remain hospitalized for some time. Although the damage caused by peripartum cardiomyopathy to the heart is irreversible, it can still function with the help of some medications and treatment. In severe cases, a heart transplant may be recommended. Women must take steps to bring blood pressure under control from the time they wish to conceive, through certain lifestyle changes.”

Drugs such as beta-blockers can help reduce blood pressure. Diuretics are another class of drugs that help lower blood pressure by removing excess water and salt from the body. Some other treatment options include coronary artery bypass surgery and implantable cardioverter defibrillators.

Some tips to control and prevent high blood pressure from HCFI

  • Monitor your blood pressure before, during, and after pregnancy. Consume less salt as a high intake can raise blood pressure.
  • Be physically active even during pregnancy. Sedentary women are likely to gain more weight than required, which can increase the risk of hypertension.
  • Make sure you are not taking medication that can raise blood pressure levels. If you already have high blood pressure, talk to your doctor about the steps that need to be followed.
  • Get regular prenatal checkups.
  • Tobacco and alcohol are not safe during pregnancy and must be avoided.

Half of Indians unaware of their hypertension status and have not received a diagnosis

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The condition is a silent killer and damages other organs over time

New Delhi, 14th May 2019: According to a recent study, only 3 out of 4 individuals in India with hypertension have ever had their blood pressure measured. Only about 45% had been diagnosed, and only 8% of those surveyed had their blood pressure under control. More than half the number of Indians aged 15 to 49 years with hypertension were not aware of their hypertension status. The awareness level was lowest in Chhattisgarh (22.1%) and highest in Puducherry (80.5%).[1]

Hypertension is a major risk factor for cardiovascular disease, a leading cause of death in India. It is defined as a repeatedly elevated blood pressure exceeding 140/90 mmHg. Hypertension generally doesn’t cause any outward signs or symptoms but silently damages blood vessels, and other organs. There is a need to create awareness about the fact that hypertension is not a disease but a sign that something is wrong in the body.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “The prevalence of hypertension in Indian adults has shown a drastic increase in the past three decades in urban as well as rural areas. It is important to get an annual checkup done after the age of 30 even if you have no family history of hypertension, are not diabetic or don’t have any other lifestyle-related disorder. For those in the high-risk category, a checkup is advised every month. Hypertension can be prevented provided a person makes necessary lifestyle changes right at the outset. It is also imperative to spread the message of prevention and encourage people across various age groups to check their blood pressure at regular intervals.”

Some signs and symptoms of hypertension include dizziness, shortness of breath, headaches, fatigue, and sometimes chest pain, palpitations, and nosebleeds.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “High blood pressure imposes an up-front burden in people who know they have it and who are working to control it. It adds to worries about health. It alters what you eat and how active you are, since a low-sodium diet and exercise are important ways to help keep blood pressure in check. Some people need medication and may need to take one or more pills a day, which can be a costly hassle.”

Some tips from HCFI.

  • Achieve and maintain a healthy weight for your height
  • Exercise regularly
  • Eat a diet that is rich in fruits, vegetables, and whole grains
  • Limit sodium intake to under 2,300 milligrams a day (one teaspoon of salt) and get plenty of potassium (at least 4,700 mg per day) from fruits and vegetables
  • Drink alcohol in moderation, if at all
  • Reduce stress
  • Monitor your blood pressure regularly, and work with your doctor to keep it in a healthy range

[1] Research published in PLOS Medicine, and carried out by researchers at the Public Health Foundation of India (PHFI), Harvard T.H. Chan School of Public Health, the Heidelberg Institute of Global Health, the University of Birmingham and the University of Gottingen.

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