Prevention of stress-induced hypertension in hypertensive patients

The aim of the study was to assess the course of the alerting reaction during an effective antihypertensive treatment, and to discuss its interference with the conduct of therapy. In 28 patients suffering from mild to moderate hypertension, the basal blood pressure was measured in an outpatient clinic according to a standardized procedure, first by a nurse, then by a 12-min recorded monitoring, and then by a physician using a mercury sphygmomanometer with the patient in the upright and then the supine position. In comparison with the monitoring (mean values recorded at 6, 9, and 12 min), there was a significant increase in diastolic and systolic blood pressure taken by the nurse and by the physician, which diminished at the end of the visit with the physician. Patients then received 10 mg of bisoprolol each morning and presented again on day 30 and day 60, following the same procedure and under identical conditions. Despite the desired antihypertensive effect, the alerting reaction persisted at each visit up to the end of the study, being unchanged in the case of the systolic blood pressure and accentuated in the case of the diastolic blood pressure. Our results confirm those of previous investigations showing that even an effective antihypertensive therapy is unequivocally associated with a persisting alerting reaction irrespective of the antihypertensive drug applied. Thus, patients may be exposed to the potential risk involved with false failures and unnecessary overtreatment. The physician must compare his or her own measurements with readings made outside the consulting office and must program ambulatory blood pressure monitoring in the case of discrepancy. This is a suitable means of confirming and validating blood pressure measurements, as this method does not record the alerting reaction.