White coat hypertension is also known as clinical or isolated in-office hypertension. The person with the disease has blood pressure values above normal parameters when measured in a clinical setting (clinics, health centers, hospitals, etc. ).
However, when pressure is measured outside the clinical environment, the values are within a normal range, although white coat hypertension has been recognized for many years as a pathology, some aspects have not been clarified, let’s first look at some key concepts to better understand the phenomenon of hypertension in white robes.
- Blood pressure is the force exerted by the bloodstream against the arterial wall; this pressure is critical for blood to circulate through blood vessels and provide oxygen and nutrients to all organs in the body so that they can function properly.
Blood pressure has two components
Two abnormalities or blood pressure dysfunctions may occur:
As we said earlier, white coat hypertension occurs in some people when they go to hospitals or related places, such as medical appointments.
White coat hypertension can be defined as a warning reaction when the patient is in the presence of a doctor. This alert reaction is a complex and stereotypical response to a potentially threatening emotional stimulus. This reaction is characterized by an increase in blood pressure and heart rate. when the doctor prepares to measure a patient’s blood pressure; in other words, it is activated by the presence of the doctor during the measurement.
It is curious that if the person measuring blood pressure is a friend, family member or patient himself, the alert reaction does not occur. Nurses can trigger the same effect, but to a lesser extent.
The European Society of Cardiology (ESC) has proposed the following diagnostic criteria for the management of high blood pressure:
Patients prone to white coat hypertension have the following characteristics:
Should the patient’s heart be hypertensive? Pump blood more effortly as it circulates under increased pressure. If this occurs for a long time (usually years), the heart muscle must “gain weight” (hypertrophy) so that the blood can be boosted more strongly with each pulse.
So far no mechanism has been clearly identified to explain why this phenomenon occurs, however, we have found evidence that we set out below:
We all experience an increase in blood pressure and heart rate in the face of a stimulus that we perceive as threatening (stressful). For people with the effect of white coat, this threatening or exhausting stimulus would be the clinical context, so when exposed to it, they would undergo the physiological changes characteristic of a response to stress, so this hypertension would not be caused by cholesterol or any other physiological cause, but by stress itself.
Thus, this effect is the result of a conditioned response to the clinical or hospital environment, not to the stimulation of a white coat. By conditional response we mean a reflexive reaction or a response learned during a stimulus. Is she conditioned? Because it appears after the learning condition was given, the experience of associating the stimulus.
Conditioned responses are thus manifested by the body in the face of so-called conditional stimuli. On the subject of interest, the conditioned stimulus would be the clinical or hospital environment. The answer would be an increase in the activity of the sympathetic self-contained nervous system. and a decrease in parasympathetic autonomous nervous system activity.
The sympathetic autonomous nervous system is responsible for symptoms of nervousness, restlessness, stress, etc. , while the parasympathetic autonomous nervous system does the opposite, is responsible for feelings of tranquility and relaxation.
Thus, in white coat hypertension, there is increased activity of the sympathetic nervous system, which increases heart rate, blood pressure and promotes tachycardia; however, evidence suggests that increases in heart rate are mainly caused by lower heart rate activation. parasympathetic system.
The terms? E?White blouse hypertension?are used incorrectly interchangeably. The effect of white gown refers to the transient increase in blood pressure that occurs as an alert reaction. This alert reaction is mainly caused by the clinical environment.
On the other hand, with white coat hypertension, we refer to the clinically hypertensive patient in the doctor’s office, on the other hand, this patient’s blood pressure values are kept within normal ranges during their daily activities. Is the blouse not related to basal blood pressure?or outside the medical setting, and may occur in patients with or without high blood pressure.
As we have seen, the hypertension of the laboratory gown is essentially generated and modulated by psychological factors, the person experiences an increase in blood pressure and heart rate in the face of a conditioned stimulus, such as the hospital or clinical environment. treatment should also be psychological.
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