Types of hypertension (high BP) based on clinic and Home BP monitoring

Three groups of high BP

When the BP is consistently more than 140/90 mmHg,hypertension (high BP) is diagnosed. Usually diastolic BP(Lower reading) is higher in younger people and the systolic  BP(Upper value) is higher in older people. As the age increases the elastic large arteries become very stiff and the systolic BP increases.

Single office reading of High BP should not be used for diagnosing Hypertension. Because the new ambience (hospital or clinic atmosphere) may transiently increase the BP in majority of people which may come down to normal after some time.

Three groups of high BP are seen

1.White coat hypertension:

Here every time the BP recorded in the clinic or hospital will be higher than normal. When the person goes home and checks the BP, it will always be within normal limits. This is called as white coat hypertension. Almost 30% of patients with high BP in the clinic will have normal BP in their house.

This is commonly seen in women, older adults and  non-smokers. So  it is important to find out this particular group of patients to avoid unnecessary lifelong treatment with potential side effects especially in older people.

2.Masked hypertension:

It is normal BP while measured in clinic but high when measured at home or out of clinic settings. It is common in elderly men, smokers, diabetics and kidney patients.  They are at higher risk for heart attack and brain storke, These patients should be treated with antihypertensives and normal BP should be achieved to reduce the risk.

3.True hypertension:

These people have high BP both in the clinic and out of clinic settings.They need medications along with life style changes if necessary.

Methods to monitor BP out of the clinic to diagnose True hypertension are :

1. 24 hrs Ambulatory BP monitoring
2. Home BP monitoring