Blood pressure readings can be tricky, especially when you take them in certain environments. In general, a person’s blood pressure varies throughout the day. A normal blood pressure reading is defined as a systolic pressure of less than 120 and a diastolic pressure of less than 80. When the blood pressure is consistently 140/90 mm Hg or higher, it is considered high blood pressure or hypertension. 

Interestingly, there are people whose blood pressure reading changes as per their surroundings and the setting they are in. While some people, who usually have normal blood pressure, get elevated readings in a doctor’s clinic, on the other hand, people have normal blood pressure readings at the doctor’s office, but experience spikes when they take it at home. The former is called White Coat Hypertension, whereas the latter is known as Masked Hypertension. 

Also Read: Reasons Why People Develop High Blood Pressure. Know Prevention and Treatment of Hypertension

Hypertension As A Silent Killer

Speaking with the OnlyMyHealth team, Dr Gaurangi Shah, Consultant-General Medicine, PD Hinduja Hospital and Medical Research Centre, Mahim, described hypertension as a ‘silent killer,’ as it accounts for 50% of heart attacks and 70% of paralysis. 

After diabetes, blood pressure is the second leading cause of kidney failure and in 85% of the cases when your blood pressure shoots, you don’t have any symptoms, she explained further. 

In addition, the doctor expressed her disappointment saying that high blood pressure is still not considered a disease, which is why in the statistics all over the world, only 10% of hypertensive people are on the correct dose of correct medicine and the rest of 90% are either on improper dose or improper medicine, “That is the reason despite having so much advancement in the medical science, the number of cases of heart attack or paralysis because of blood pressure are not going down or kidney failure the same way,” she said.  

According to the World Health Organization (WHO), more that 100 crore adults aged 30-79 have hypertension worldwide, with an estimated 46% unaware that they have the condition.

Moreover, only 42% of adults with hypertension are diagnosed and treated, and just 1 in 5 adults have it managed effectively. 

How High Blood Reading Changes According To Environments

It is important to know that blood pressure readings fluctuate throughout the day. In fact, it keeps changing depending on the body’s environment, according to Dr Shah. This is one of the primary reasons why healthcare professionals recommend measuring blood pressure at least twice daily, taking two or three readings in consideration each time to ensure you have the same results. 

“In winter, due to cold, our body tries to conserve the energy or heat within the body so you have what we call vasoconstriction – where your arteries and veins get contracted and that increases your blood pressure. Therefore, we see more heart attacks and paralysis during winter than summer,” the doctor said. 

According to the Mayo Clinic, other causes of higher blood pressure include weight gain, salty foods often eaten during the holidays and decreased physical activity that are common in winter.

Also Read: World Hypertension Day 2022: Know The Types of Hypertension

Understanding White Coat And Masked Hypertension

Explaining what white coat hypertension is, Dr Shah said, “It occurs whenever a person visits doctors in the hospital, who are usually wearing a white coat. Some patients get anxious or apprehensive or stressed and that increases their blood pressure transiently. However, if they check their blood pressure at home, it can be normal.”

“For these patients, we recommend ABPM, ambulatory blood pressure monitoring, where your machine is attached to the body and that machine measures BP reading at frequent intervals throughout 24 hours. This way we can accurately diagnose whether the person actually has hypertension or is it because of the doctor’s presence,” she added. 

On the contrary, masked hypertension occurs when blood pressure readings do not increase in the office or a clinical setting, rather spikes in an out-of-office environment, which includes home blood pressure monitoring or by ambulatory blood pressure monitoring. 

According to a 2017 study published in the Annals of Translational Medicine, masked hypertension is estimated to occur in 10-30% of people. 

Another study published in the Journal Frontiers in Physiology suggests that the prevalence of white coat and masked hypertension was 5.1 and 15.2%, respectively. The study involved 461 participants with an average age of 49 years. It was found that smoking and family history of coronary heart disease were associated with higher odds of white coat hypertension. The associated factors for higher prevalence of masked hypertension were smoking, family history of hypertension, and family history of coronary heart disease.

How To Manage High Blood Pressure

When it comes to managing hypertension, a well-balanced diet, regular exercise and reduced stress levels are integral. The goal of managing and treating blood pressure is to prevent the risk of organ damage, Dr Shah emphasised.  

“You need to maintain your blood pressure below 130 by 80 throughout 24 hours,” said the doctor, adding, “We call it ‘goal BP’, which is less than 130 by 80.”

“All hypertensive patients should visit their doctor for dose titration so that over a period of time, uncontrolled high blood pressure does not cause kidney failure, heart attack, or eye or brain damage,” she added.