Why high blood pressure is misdiagnosed 40% of the time

Causes of BP misdiagnosis are whitecoat hypertension (BP rising due to anxiety when you visit the doctor) and masked hypertension (hypertensive patient shows normal blood pressure readings at a doctor’s clinic).

Myupchar August 29, 2019 17:48:03 IST
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Why high blood pressure is misdiagnosed 40% of the time
  • Hypertension, or simply high blood pressure, is one of the most common cardiovascular conditions, affecting a wide range of people all over the world

  • Blood pressure can rise due to anxiety when you visit the doctor - this condition is known as whitecoat hypertension and it increases the chances of misdiagnosis

  • Masked hypertension is a condition in which a hypertensive patient shows normal blood pressure readings at a doctor’s clinic but high blood pressure at home

Hypertension, or simply high blood pressure, is one of the most common cardiovascular conditions, affecting a wide range of people all over the world. According to the National Health Portal of India, one in every five adults suffers from high blood pressure. However, due to the absence of any apparent symptoms, it is often ignored and/or misdiagnosed. Estimates suggest that 50% of patients don’t even know they have hypertension.

Recent reports by the India Heart study (IHS), the nation’s biggest study focusing on the importance of home-based blood pressure monitoring, now show that hypertension misdiagnosis is much more common than anticipated in India. This severely worsens the prognosis of hypertensive patients - high blood pressure is the most common cause of heart diseases and stroke.

Why high blood pressure is misdiagnosed 40 of the time

Representational image. Reuters

What is hypertension?

Blood pressure is the force your blood puts on blood vessel walls while it's flowing through the body. It is measured in mm of mercury: mm Hg. A blood pressure reading of more than 140 mm Hg systolic pressure (denoted by the upper number) and 90 mm Hg diastolic (lower number) is considered hypertension.

Hypertension can be caused due to several factors like unhealthy lifestyle, stress, obesity, and genetics. Growing older, excessive salt intake and secondary conditions like diabetes increase the risk of hypertension. Interestingly, men are more prone to high blood pressure than women. However, regardless of the cause, most hypertensive people don’t really show any apparent symptoms.

Uncontrolled blood pressure may manifest in the form of headache, fatigue, confusion, breathing difficulties, chest pain, palpitations and hematuria (blood in urine). In serious cases, it can lead to complications such as coronary heart disease, heart attack, and chronic kidney failure. High blood pressure is responsible for about 10.8% of deaths in India, as per the Indian Council of Medical Research.

Regular monitoring of blood pressure is important if you fall in any of the high-risk categories.

Difficulties in diagnosis

Hypertension is mainly diagnosed through a sphygmomanometer (blood pressure machine) reading. Sphygmo means “related to pulse”, and a manometer is a device to measure pressure.

However, your blood pressure can rise due to anxiety when you visit the doctor - this condition is known as whitecoat hypertension and it increases the chances of misdiagnosis.

On the other hand, some people have masked hypertension. It is a condition in which a hypertensive patient shows normal blood pressure readings at a doctor’s clinic but high blood pressure at home. According to the University of Wisconsin Hospitals and Clinics Authority, U.S., masked hypertension is seen more commonly in men, alcoholics, tobacco users and people who live in an otherwise stressful environment. Such people show normal blood pressure readings at the doctor’s office but have high blood pressure soon after they go back to their everyday work.

In the IHS study, lead investigator Professor Dr Upendra Kaul - Chairman Batra Heart Centre and Dean Academics and Research Batra Hospital, a Medical Research Centre, New Delhi - explained that whitecoat hypertension and masked hypertension lead to misdiagnosis in about 40% of cases in India.

Due to these conditions, non-hypertensive people end up being prescribed with blood pressure-lowering medications. On the other hand, people suffering from high blood pressure go without treatment.

Furthermore, he added that Indians have a much higher resting heart rate - 80 beats per minute compared with 72 beats per minute in the West. Blood pressure readings in most Indian patients are noted to be much higher in the evenings than during the morning. Clearly, there is a need to reconsider the right timing for the administration of anti-hypertensive drugs for Indians.

For accuracy of diagnosis, doctors already suggest that at least three different readings should be taken at the clinic.

Treatment

Hypertension can’t be cured completely but it is manageable with a combination of anti-hypertensive medications and healthy lifestyle and dietary habits. Drugs like beta-blockers, ACE inhibitors and diuretics are given to avoid hypertension complications. Lifestyle habits like quitting smoking, weight management, reducing stress, regular exercise and a DASH diet (Dietary Approach to Stop Hypertension) are generally recommended.

It is important to seek medical support if you are suffering from hypertension. Timely and prompt diagnosis may go a long way in promoting longevity and improving the quality of life.

Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health. To know more on this topic, please visit https://www.myupchar.com/en/disease/blood-pressure-high

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