Severe Hypertension .net

Site updated at Thursday, 03 December 2015

Health

Detecting Isolated Clinic Hypertension

Saturday, Dec 22 2007

  

Because patients with isolated clinic hypertension have presumably less risk for cardiovascular complications than essential hypertensive patients, there is a question about whether treatment is necessary in this group. Additionally, there have been some reports that anti-hypertensive treatments are less effective in decreasing blood pressures observed in isolated clinic hypertensive patients (Fitscha and Meisner, 1993; Pickering et al., 1994). Therefore, in order to make optimal treatment recommendations, it is important for the physician to distinguish isolated clinic hypertensive patients from those with established hypertension.

Unfortunately, there are few guidelines that will assist a physician in making this distinction. For example, although it is known that more women than men exhibit isolated clinic hypertension (Myers and Reeves, 1995; Pickering et al., 1988), this information is not very useful for determining the appropriate diagnosis when examining a new hypertensive patient in the clinic. It has also been reported that isolated clinic hypertension is more frequent among nonsmokers, and among persons with low clinic DBP and low left ventricular mass (Verdecchia et al., 2001).

Knowledge of these variables, too, provides the physician with very little guidance in establishing an appropriate diagnosis and treatment plan. Physicians are not going to dismiss a new patient as having isolated clinic hypertension and not offer treatment just because she is a nonsmoker. As stated above, there is also no evidence that obtaining measures of self-reported anxiety yields any helpful information to the physician regarding making this distinction (Gerardi et al., 1985; Siegel et al., 1990).

After examining the literature on isolated clinic hypertension, Verdecchia et al. (2003) derived the following list of factors that might cue a physician to consider the presence of isolated clinic hypertension and recommend ambulatory blood pressure monitoring: female gender, nonsmoking status, newly diagnosed hypertension, limited exposure to clinic settings, and low left ventricular mass. In an analysis of potential predictors of isolated clinic hypertension, Larkin et al.

image Figure 2.3. Clinic SBPs for isolated clinic hypertensive (ICH) and essential hypertensive (EH) patients. Blood pressure determinations for each of three clinic visits were made immediately upon arrival to the clinic and after 10, 15, and 20 minutes of quiet rest. Data collection supported by the American Heart Association, West Virginia Affiliate (Grant 93-7854 S).

(1998b) confirmed that there is very little the physician can do during an initial clinic visit that can corroborate presence of isolated clinic hypertension. From a wide range of potential predictors of isolated clinic hypertension in this study, only two strategies were found to discriminate isolated clinic hypertension from sustained essential hypertension, home blood pressure monitoring and the degree of blood pressure habituation across clinic visits.

Obviously, isolated clinic hypertensive patients reported lower blood pressures during a week of home blood pressure monitoring in comparison to the sustained hypertensive group. Regarding the degree of habituation across clinic visits, although SBPs of patients with isolated clinic hypertension were indistinguishable from essential hypertensive patients during the first visit to the clinic, they tended to habituate during subsequent visits as the patients grew accustomed to the clinic environment (see Figure 2.3). A comparable effect, however, was not observed for DBP.

Turner, S. M., Beidel, D. C., and Larkin, K. T.
Published with assistance from the foundation established in memory of Amasa Stone Mather of the Class of 1907, Yale College.

References
  • Abel, J. A., and Larkin, K. T. (1991). Assessment of cardiovascular reactivity across laboratory and natural settings. Journal of Psychosomatic Research, 35, 365 - 373.
  • Achmon, J., Granek, M., Golomb, M., and Hart, J. (1989). Behavioral treatment of essential hypertension: A comparison between cognitive therapy and biofeedback of heart rate. Psychosomatic Medicine, 51, 152 - 164.
  • Agras, W. S., Horne, M., and Taylor, C. B. (1982). Expectation and the blood-pressure-lowering effects of relaxation. Psychosomatic Medicine, 44, 389 - 395.
  • Agras, W. S., Taylor, C. B., Kraemer, H. C., Southam, M. A., and Schneider, J. A. (1987). Relaxation training for essential hypertension at the worksite: II. The poorly controlled hypertensive. Psychosomatic Medicine, 49, 264 - 273.
  • Aivazyan, T. A., Zaitsev, V. P., Khramelashvili, V. V., Golenov, E. V., and Kichkin, V. I. (1988). Psychophysiological interrelations and reactivity characteristics in hypertensives. Health Psychology, 7, 137 - 144.
  • al'Absi, M., and Wittmers, L. E. (2003). Enhanced adrenocortical responses to stress in hypertension-prone men and women. Annals of Behavioral Medicine, 25, 52 - 33.
  • Albright, C. L., Winkleby, M. A., Ragland, D. R., Fisher, J., and Syme, S. L. (1992). Job strain and prevalence of hypertension in a biracial population of urban bus drivers. American Journal of Public Health, 82, 984 - 989.
  • Davidyan, A. (1989). Emotional factors in essential hypertension. Psychosomatic Medicine, 55, 505 - 517.
  • Alfredsson, L., Davidyan, A., Fransson, E., de Faire, U., Hallqvist, J., Knutsson, A., et al. (2002). Job strain and major risk factors for coronary heart disease among employed males and females in a Swedish study on work, lipids, and fibrinogen. Scandinavian Journal of Work, Environment and Health, 28, 238 - 248.
Revision date: March 9, 2010
Last revised: by Dr. Debbie Bollec, M.D.

Provided by Armina Hypertension Association

Post a comment [ + Comment here + ]

There are no comments for this entry yet. [ + Comment here + ]




Comment
Your details

* Required field


Please enter the word you see in the image below:

Comments are moderated by our editors, so there may be a delay between submission and publication of your comment. Offensive or abusive comments will not be published.


This website is accredited by Health On the Net Foundation. Click to verify. We comply with the HONcode standard for trustworthy health information:

verify here.