High blood pressure caused by physician anxiety quantified in new study

Are physicians making their patients’ blood pressure rise? According to a new study, physicians are recording higher blood pressure readings than their nurses, and this could be causing an increase in unnecessary treatment.

More than 1,000 patients from 10 countries had blood pressure levels measured from both doctors and nurses. Doctors’ readings were often significantly higher than nurses’-on average by 7/4 mmHg, according to a review led by the University of Exeter Medical School in the United Kingdom. Though researches have known for years about this phenomenon, this study is the first to quantify higher blood pressure readings, according to the researchers.

“Doctors should continue to measure blood pressure as part of the assessment of an ill patient or a routine check-up, but not where clinical decisions on blood pressure treatment depend on the outcome,” says Christopher Clark, PhD, FRCGP, general practitioner and clinical academic fellow at the Exeter Medical School. “The difference we noted is enough to tip some patients over the threshold for treatment for high blood pressure, and unnecessary medication can lead to unwanted side effects.”

Clark adds that the pressure of asking patients to monitor blood pressure, coupled with having a physician and a nurse also taking readings could be causing unneeded stress to patients. “Some patients may be erroneously asked to continue to monitor their own blood pressure at home, which can build anxiety. These inappropriate measures could all be avoided by the simple measure of someone other than a doctor taking the blood pressure recording,” Clark says.

Researchers call this “white coat hypertension,” where patients’ anxiety toward doctors cause higher blood pressure readings. Though once considered a temporary increase, studies have shown that when a patient has elevated blood pressure in a medical office, it can often lead to higher overall blood pressure levels. Other recent studies suggest that up to 20% of the United States’ 67 million adults with hypertension could suffer from false readings, some caused by anxiety in doctors’ offices.

The Exeter Medical School study is a part of a 10-year research project that assesses primary care access. This study, along with others that measure mental health, cardiovascular health, and patient care will continue to make primary care more comprehensible to patients, says John Campbell, professor of general practice and primary care at the Exeter Medical School and a co-author of the study.

“Increasing doctors’ awareness of factors which might affect the accurate assessment of blood pressure is of great importance since this is one of the commonest clinical assessments undertaken, and one where important decisions regarding a patient’s health and well-being may follow,” Campbell says.