Tuesday, May 11, 2010
In the Really? column in this week's Science Times (NY Times) Anahad O'Conner discusses white-coat hypertension, the so-called phenomenon that patients with 'normal' blood pressure (normotension) will show abnormally high readings in the doctor's office due to increased anxiety in a medical setting. The high readings have been dismissed when the patients blood pressure is normal outside of the doctor's office, or at home.
As a practitioner of Traditional Chinese Medicine (TCM) I have felt that these high readings are information about how the patients body reacts to stress and anxiety. If the blood pressure goes up in the doctors office, then it also goes up in other circumstances when the patient is under stress. I have felt this patient should be treated to address the condition.
Well apparently studies are showing that white-coat hypertension is 50% predictive of developing sustained hypertension (experienced also at home, or outside of medical settings). A 2005 study published in the Archives of Internal Medicine followed 128 people for 8 years. Those with white-coat hypertension had a 47% rate of developing primary hypertension, compared to 22% of those with with normotension (normal blood pressure).
The findings were repeated in a 2009 study published in Hypertention magazine that followed 1400 people for 10 years. 43% of the white-coat hypertensives and 47% of the masked hypertensives developed into sustained hypertension.
Acupuncture is effective in lowering blood pressure, over time. In my clinic I use a combined approach of acupuncture and Chinese herbal formulas. As treatment progresses and blood pressure stabilizes I recommend patients work with their doctor or pharmacist to begin safely lowering the dosage of the anti-hypertensive medications and see which can be eliminated. We work toward eliminating all anti-hypertensive medication. Once the patient has stopped the medications we begin decreasing the frequency of acupuncture treatments, while continuing the herbal formulas to control the blood pressure. Once the patient can sustain normal blood pressure for several months with monthly or even 6 week intervals between acupuncture treatments the herbal dosages are reduced, working towards eventual elimination of acupuncture and herbs.
Hypertension is a chronic condition, generally having gone on for some years prior to the patience commencing TCM treatment. Acupuncture and herbs are therapies, requiring continued treatment to achieve clinical success. Response is individual, generally speaking for chronic conditions continued care will be necessary for some time. However my goal of treatment is always to be able to carefully withdraw acupuncture and herbal therapy and maintain a state of symptom-free equilibrium. When symptoms recur, the patient quickly returns to the office and generally a short course of treatment will resolve the issue. In the case of hypertension, generally stress causes the blood pressure to rise, and often a new life stress issue will need to be addressed to return the patient to normotension. KB