Blood pressure measurement study highlights need for better clinical management.

Nearly 42% Indians are either misdiagnosed or have missed diagnosis of hypertension, a study has found. Medical experts say this phenomenon leads to unnecessary medication or lack of medication leaving patients exposed to risk factors.

The blood pressure (BP) measurement study covering 18,918 Indians has revealed nearly 24% people had white coat hypertension — a syndrome wherein a patient records high BP when measured in a doctor’s clinic. Around 18% Indians had masked hypertension — a syndrome wherein a person records normal BP at a clinic, but records a spike when measured at home.

“The study shows the urgent need for a better clinical management of hypertension in the country. On one hand, we have white coat hypertensives getting unnecessary medication and on the other, we have masked hypertensives who don’t get medication. Both situations are equally dangerous,” said interventional cardiologist Dr. Upendra Kaul, principal investigator of the study commissioned by Eris Lifesciences, a pharmaceutical company. “Masked hypertensives are mostly those who have unexplained kidney disease,” he said.

According to Dr. Kaul, the difference between the BP readings at clinic and home is mainly due to anxiety and apprehension of the patient or a glitch from the doctor’s side who is often looking at a large number of patients.

The study involved 1,233 doctors across the country who first measured the BP at their clinic and then handed over a BP measuring device to the patient to record the values at home for seven consecutive days and twice daily. After a week, the patient’s BP was recorded at the doctor’s clinic for a second time and all the readings were analysed for the study. In Mumbai, of the 1,643 people studied, nearly 22.8% were white coat hypertensives and 51.4% were masked hypertensives.

The study also revealed that first day BP values were unreliable and BP readings taken in the evening were often higher than morning, which debunks the popular belief about the morning surge in BP.

Dr. Willem Verberk, a specialist in BP measurements from the Netherlands, who was also part of the study, said BP values fluctuate constantly. “Measuring the BP over seven days is more reliable,” he said, adding nearly 70% of doctors use a mercury sphygmomanometer device which needs to be calibrated every six months for accurate readings. “But very few doctors actually calibrate it.” Doctors said mercury-based devices have been banned and that digital devices also known as oscillometric devices are more reliable.