NMU 50 – High Blood Pressure Misdiagnosed in 20% of Patients
Nutrition / Natural Medicine Update No. 50 (April 7, 2017)
with Dr. James Meschino
Research Topic: High Blood Pressure Misdiagnosed in 20% of Patients
Source: Journal: Canadian Family Physician (March 2017)
The study I am citing today was published in the journal, Canadian Family Physician on March 1, 2017. and deals with the diagnosis of high blood pressure in Canada. The researchers of the study concluded that 20% of people receiving treatment for high blood pressure (hypertension) don’t actually have a problem and do not need medication. “This is due mainly to the fact that their blood pressure was improperly measured,” according to the lead author of the study, Janusz Kaczorowski.
The study was conducted by researchers at the University of Montreal Hospital Research Centre (CRCHUM), which showed that more than half of family doctors in Canada are still using manual devices to measure blood pressure, a dated technology that often leads to misdiagnosis. The traditional way to measure blood pressure was done manually with a sphygmomanometer and a stethoscope. But over the past 20 years automatic electronic measuring devices, known as oscillometric devices, have become available, and studies show that they provide more accurate readings.
In 2016, The Canadian Hypertension Education Program (CHEP) Guidelines recommended that electronic measurement is preferable to manual measurement. The 2017 study showed that 52% of Canadian family doctors sill use the manual method of blood pressure assessment, while only 43% have switched to the automatic devices. The automatic devices are more expensive but more precise because they take several measurements and they eliminate what’s known as the white-coat syndrome, which refers to artificially high blood pressure resulting from the stress of being in a doctor’s office and human interaction.
In other words, the stress of having your blood pressure taken manually, for some people, can cause a burst of activity in your nervous system that causes your heart to contract with more force and the muscular walls around your blood vessels to tighten, which in turn elevate both your systolic and diastolic pressure. Systolic pressure measures how hard your heart is contracting and diastolic pressure measures how much resistance there is to blood flow in your arteries. As a result, it is easy for high blood pressure to be over diagnosed using the manual method of blood pressure assessment.
However, manual measurement is acceptable if it’s done properly, but that’s often not the case. To take manual blood pressure the right way, a 12- to 15-minute period is required so the patient can’t be left alone in the room in a relaxed position. We know that the average visit to a family doctor lasts 10 minutes, so the patient is often still a bit of a stressed or anxious state when blood pressure is taken without having ample opportunity to compose themselves and get sufficiently relaxed before the measurement is taken. The CHEP Guidelines state that modifying health-related behaviors is an efficient way of preventing and treating high blood pressure and of reducing the risk of cardiovascular disease. It is possible to lower blood pressure through a healthy diet, regular physical activity, moderate alcohol consumption, reduced intake of dietary sodium, avoidance of exposure to tobacco products, and stress management. In Canada, one in five adults suffers from hypertension which represents “the greatest global risk factor for death and disability.” In Canada, healthcare costs attributable to hypertension was more than $13 billion in 2010.
So, in summary, there are several things for you to act on:
1.Get your blood pressure assessed. Make sure it is under 140/90, more ideally under 130/80 and most optimally 120/70.
2. If possible, get your blood pressure taking from a physician using an automated device.
3. If your physician is using the manual method, then insist they provide a quiet place within their office where you can sit or lie down and become fully relaxed for 12-15 minutes prior to your blood pressure being taken to avoid a misdiagnosis and unnecessary treatment with medication.
4. If your blood pressure is high, then adhere to the medication prescribed to lower your blood pressure, as high blood pressure is a cardinal risk factor for stroke, heart attack, and chronic kidney disease. You cannot walk around with high blood pressure without it catching up with you at some point.
5. If your blood pressure is high, then review and act on the dietary, exercise and other lifestyle measures shown to help lower blood pressure. In many cases, acting on these strategies will enable your physician to lower the dosage of your medication (which reduces drug side effects) or eliminate the need for medication altogether. The World Health Organization states that 75% of high blood pressure cases are in the mild to moderate range, whereby lifestyle modification alone can reduce blood pressure to normal in a high percentage of cases.
I’ve included a link to the research paper below.
Janusz Kaczorowski, Martin G. Myers, Mark Gelfer, Martin Dawes, Eric J. Mang, Angelique Berg, Claudio Del Grande and Dragan Kljujic. How do family physicians measure blood pressure in routine clinical practice? Canadian Family Physician. 2017, 63;3 http://www.cfp.ca/content/63/3/e193
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