White coat hypertension – when a patient exhibits high blood pressure in the doctor’s office - has received substantial attention in research for good reasons: Patients with elevated BP in clinical environments are 36% more likely to have a cardiac event (Annals of Internal Medicine 2019).

Treating white coat hypertension has multiple complexities. For example: prescribing BP medication based on an artificially high clinical reading will lower otherwise normal blood pressure once the patient is home. Since BP medication is often taken for life (and may have side effects), the stakes are high for accurate BP monitoring - especially among the elderly, who may be more prone to white coat hypertension than other age segments.

The need for accurate BP monitoring opens an opportunity for medically directed home healthcare to ensure cardiology care teams receive a steady, accurate flow of BP data for elderly patients.

Key obstacles in treating elderly hypertension

In addition to being more prone to white coat hypertension, elderly patients present a number of challenges for cardiologists. A recent report in Clinical Cardiology (2019) pinpointed several challenges related to geriatric cardiology and hypertension. To paraphrase:

  1. Making decisions based on age. Chronological age does not determine the physical, social and mental health of the person.
  2. Practicing personalized medicine. This requires reliable knowledge of the patient’s family and personal health history.
  3. Understanding co-morbidities. Frailty, cognitive decline, and other characteristics of old age must be understood alongside medical conditions, such as dementia.
  4. Ruling out “false” hypertension (HTN). This includes identifying pseudo HTN (from the cuff BP method), masked HTN (higher BP at home than in a doctor’s office), and situational HTN (caused by stressful circumstances and/or diet).

To address these issues effectively, home healthcare services should be considered for two main reasons:

  1. Home-based caregivers tend to know their clients well, including their health history, stress triggers, and family caregivers and
  2. Medically directed home care professionals understand the role and practice of BP monitoring as well as medication management, diet, exercise, stress reduction, and other non-pharmacologic interventions.

Adults with white coat hypertension

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1 in 5

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A Penn Medicine study (2019) published in the Annals of Internal Medicine reported this finding: “Patients with untreated white coat hypertension not only have a heightened risk of heart disease, but they are twice as likely to die from heart disease.” Jordana B. Cohen, MD, MSCE, the study’s lead author, said in a news release “Studies suggest that about one in five adults may have white coat hypertension…We believe individuals with isolated in-office hypertension…should be closely monitored for transition to sustained hypertension, or elevated blood pressure both at home and the doctor’s office.”*

Challenges and opportunities of home BP monitoring

New, ambulatory blood pressure monitors that the patient wears can automate BP readings, but most doctors still rely on home BP monitoring performed by the patient. However, this tends to be less reliable because patients misread or ignore the results.

“New technology can be helpful,” said SeniorBridge Director of Client Services Deb Hess. “But obtaining consistent trends in blood pressure is what we want. Taking a person’s blood pressure daily while the person is in their home, on one or both arms, sitting and standing, can indicate ongoing results that need intervention.”

It can be argued that, especially for elderly hypertension patients, telemedicine adds a significant advantage in managing hypertension. As the previously cited Clinical Cardiology report identified, “The use of telemedicine to manage our patients is a modern tool that will improve our management in older persons that require slow and careful adjustments in their medication, without asking them to overcome the hurdles of transportation, walking and time of having a clinic visit.”

New technology can be helpful, but obtaining consistent trends in blood pressure is what we want.

Deb Hess

SeniorBridge Director of Client Services

The integrated care management model by SeniorBridge

Home care services vary widely in the services they provide.

SeniorBridge offers an integrated care management practice model that involves two components:

  1. Clinical care (under the direction of an RNCM/Registered Nurse Care Manager) supported by a Social Worker and a team of caregivers, based on patient’s needs and
  2. A portfolio of home care services and geriatric care management in such areas as nutrition, caregiver education, benefit coordination, transportation, and coordination with discharge planners, physicians, pharmacy, home health agencies, and care managers.

NOTE: We have full COVID-19 safety protocols in place to keep clients, families and associates safe.

For more information on hypertension home care support services, contact SeniorBridge.

Sources consulted:
National Library of Medicine /NIH/Journal of Clinical Hypertension (2016)
Clinical Cardiology (2019)
Penn Medicine (2019)

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