It doesn’t take much. For someone it is enough to enter the doctor’s office, see him prepare the cuff and detect the pressure, to trigger an emotional reaction that often leads to higher values than those recorded at home, while sitting comfortably on the sofa. In short, there are conditions in which it is not possible to control one’s mood and even, without obviously realizing it, blood pressure also rises. But how does this reaction arise? The answer comes from an Italian research, published on Hypertension, coordinated by Guido Grassi, professor of Internal Medicine at the University of Milano-Bicocca, who also sees among its authors a great expert such as Giuseppe Mancia.
Heart Door
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According to scholars, in practice, an “alarm” response that pervades the whole body would occur in the “emotional” hypertension, then destined to disappear when the doctor is not present. The response of particularly sensitive people would be that classic “fight or flight” that characterizes animals when faced with danger. Therefore, in reaction to such intense stress, increases in blood pressure values would also occur, as if the measurement, which helps us to control the pressure, was experienced in a completely unconscious way as a potential threat. The research looked at 18 people with mild to moderately high hypertension not being treated. To evaluate the white coat effect, four different measurements were considered, two in the presence of the doctor and two without: through a sophisticated examination, the nervous activity of the skin and muscles was checked in all circumstances.
Well, the experts have found some kind of “Congruence” between blood pressure values, number of heartbeats and nervous reaction in the area of the skin and muscles, precisely similar to that observed in animals when faced with a danger, which presupposes the need to fight or, alternatively, to run away. Obviously this reaction was observed in the presence of the doctor. When the white coat was not present, both the vascular and nervous systems behaved normally, so much so that on average for the first systolic detection (i.e. the maximum) the average difference in the presence of the doctor or not was as many as 14 percentage points . And, as if that weren’t enough, if the blood pressure was measured in solitude, the heart rate also appeared to be decreased. But be careful: if it is true that the pressure measured in the absence of the doctor for some people could turn out to be more truthful, there is no doubt that it is the doctor who must summarize the need for treatment or not and the choice of treatments, also based on the overall cardiovascular risk.
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Perhaps, given the importance of objective measurements that are not affected by the “emotional” impact, the measurements could also be entrusted to paramedics in those who are particularly sensitive. Furthermore, betting too much on the emotional reaction of the subjects could prove to be deceptive and cause potential risks to be underestimated. It does so assumes coordinated research by Jordana B. Cohen of the University of Pennsylvania, which appeared on Annals of Internal Medicine. By re-evaluating 27 different studies that considered about 60,000 people in total. Three different categories of patients were identified, who had to be monitored for three years, assessing the risk of cardiovascular events for each group. Those who had hypertension particularly related to the “white coat” still had a 36 percent increased risk of suffering from heart disease. Therefore, only the doctor, on a case by case basis, must define the treatment strategy to counter this enemy of heart and arterial health.
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