Introduction: White coat hypertension is a phenomenon in which a patient's blood pressure in a clinic setting exceeds the patient's blood pressure in other settings. Studies suggest this occurs in anywhere from ten to thirty percent of patients. The identification of such is important as it may prevent unwarranted use of anti-hypertensive medications. Objectives: The main goal of this study was to quantify the prevalence of white coat hypertension at a free blood pressure clinic in Richmond, VA. The examination of blood pressure differences between clinic settings and other settings on a group and individual level was fundamental to this study. Further analyses were then included to examine risk factors associated with uncontrolled hypertension in attempt to develop a predictive model. Methods: Longitudinal data was collected from ambulatory blood pressure monitors of 16 patients from the Richmond Center for High Blood Pressure. This data was merged with data collected from retrospective chart reviews to obtain laboratory values for possible risk factors. Paired t-tests were used to examine differences between clinic and home measurements on a group level. The examination of individual agreement and regression analysis to develop a predictive model was also undertaken. Results: Twenty-five percent of subjects included in this study suffered from white coat hypertension. Overall, there was no difference between clinic and home blood pressure measurements on the group level. However, individual agreement was poor. Regression analysis showed high density lipoprotein was positively associated with and triglycerides were negatively associated with an increased percent of uncontrolled hypertension. Conclusion: White coat hypertension is a phenomenon that is present at the Richmond Center for High Blood Pressure. Recognition of this has the potential to be economically advantageous for the clinic. Due to a small sample size, results of this analysis are not considered predictive models. However, future research in this field would be served well to explore these preliminary findings with larger samples.

This book addresses all aspects of white coat hypertension – the phenomenon of raised blood pressure in a medical setting yet not elsewhere – from its history to its pathophysiology, diagnosis and treatment. White coat hypertension is a common condition, accounting for 30–40% of the overall hypertensive population. While many studies have addressed this condition, controversy still exists over whether it causes an increased risk to sufferers and should be treated. In the volume neurogenic and non-neurogenic mechanisms are discussed and the significance of various predictive factors, evaluated. The association of white coat hypertension with dysmetabolic risk factors, new-onset diabetes and other conditions is carefully reviewed. Further chapters consider the occurrence of asymptomatic organ damage and cardiovascular outcomes in affected patients and helpful guidance is also provided on the controversial issue of when to treat and when not to treat. White Coat Hypertension is based largely on work done during the past 30 years by renowned researchers working in Milan, who have made key contributions in improving knowledge of the condition and whose work is well known across the world.

Hypertension remains a leading cause of disability and death worldwide. Self-monitoring of blood pressure by patients at home is currently recommended as a valuable tool for the diagnosis and management of hypertension. Unfortunately, in clinical practice, home blood pressure monitoring is often inadequately implemented, mostly due to the use of inaccurate devices and inappropriate methodologies. Thus, the potential of the method to improve the management of hypertension and cardiovascular disease prevention has not yet been exhausted. This volume presents the available evidence on home blood pressure monitoring, discusses its strengths and limitations, and presents strategies for its optimal implementation in clinical practice. Written by distinguished international experts, it offers a complete source of information and guide for practitioners and researchers dealing with the management of hypertension.

How to play a vital role in your own health and longevity: A handbook from“one of the most reliable, respected health resources that Americans have” (Publishers Weekly). This easy-to-use guide will help you understand the many issues related to high blood pressure and assist you in preventing it, managing it, and making essential treatment decisions. · Learn which single factor you can do the most about when it comes to influencing your blood pressure. This one step may be all it takes to lower your blood pressure and keep it under control. · How losing as little as 10 pounds may reduce your blood pressure to a healthier level—includes practical help for maintaining a healthier weight. · Discover a great alternative that may lower your blood pressure just about as much as medications—without the expense of prescriptions. · Why your blood pressure goes down if you make your heart stronger—and dozens of tips to realize this goal. · How to manage your sodium intake. · Information about medications for when changes in lifestyle aren't enough and more

Hypertension is one of the leading causes of death in the United States, affecting nearly one in three Americans. It is prevalent in adults and endemic in the older adult population. Hypertension is a major contributor to cardiovascular morbidity and disability. Although there is a simple test to diagnose hypertension and relatively inexpensive drugs to treat it, the disease is often undiagnosed and uncontrolled. A Population-Based Policy and Systems Change Approach to the Prevention and Control Hypertension identifies a small set of high-priority areas in which public health officials can focus their efforts to accelerate progress in hypertension reduction and control. It offers several recommendations that embody a population-based approach grounded in the principles of measurement, system change, and accountability. The recommendations are designed to shift current hypertension reduction strategies from an individual-based approach to a population-based approach. They are also designed to improve the quality of care provided to individuals with hypertension and to strengthen the Center for Disease Control and Prevention's leadership in seeking a reduction in the sodium intake in the American diet to meet dietary guidelines. The book is an important resource for federal public health officials and organizations, especially the Center for Disease Control and Prevention, as well as medical professionals and community health workers.

The ultimate guide to the evidence-based clinical encounter "This book is an excellent source of supported evidence that provides useful and clinically relevant information for the busy practitioner, student, resident, or educator who wants to hone skills of physical diagnosis. It provides a tool to improve patient care by using the history and physical examination items that have the most reliability and efficiency."--Annals of Internal Medicine "The evidence-based examination techniques put forth by Rational Clinical Examination is the sort that can be brought to bear on a daily basis – to save time, increase confidence in medical decisions, and help decrease unnecessary testing for conditions that do not require absolute diagnostic certainty. In the end, the whole of this book is greater than its parts and can serve as a worthy companion to a traditional manual of physical examination."--Baylor University Medical Center (BUMC)Proceedings 5 STAR DOODY'S REVIEW! "Physical diagnosis has been taught to every medical student but this evidence-based approach now shows us why, presenting one of medicine's most basic tenets in a new and challenging light. The format is extraordinary, taking previously published material and updating the pertinent evidence since the initial publication, affirming or questioning or refining the conclusions drawn from the data. "This is a book for everyone who has studied medicine and found themselves doubting what they have been taught over the years, not that they have been deluded, but that medical traditions have been unquestionably believed because there was no evidence to believe otherwise. The authors have uncovered the truth. "This extraordinary, one-of-a-kind book is a valuable addition to every medical library."--Doody's Review Service Completely updated with new literature analyses, here is a uniquely practical, clinically relevant approach to the use of evidence in the content of physical examination. Going far beyond the scope of traditional physical examination texts, this invaluable resource compiles and presents the evidence-based meanings of signs, symptoms, and results from physical examination maneuvers and other diagnostic studies. Page after page, you'll find a focus on actual clinical questions and presentations, making it an incomparably practical resource that you'll turn to again and again. Importantly, the high-yield content of The Rational Clinical Examination is significantly expanded and updated from the original JAMA articles, much of it published here for the first time. It all adds up to a definitive, ready-to-use clinical exam sourcebook that no student or clinician should be without. FEATURES Packed with updated, new, and previously unpublished information from the original JAMA articles Standardized template for every issue covered, including: Case Presentation; Why the Issue Is Clinically Important; Research and Statistical Methods Used to Find the Evidence Presented; The Sensitivity and Specificity of Each Key Result; Resolution of the Case Presentation; and the Clinical Bottom Line Completely updated with all-new literature searches and appraisals supplementing each chapter Full-color format with dynamic clinical illustrations and images Real-world focus on a specific clinical question in each chapter, reflecting the way clinicians approach the practice of evidence-based medicine More than 50 complete chapters on common and challenging clinical questions and patient presentations Also available: JAMAevidence.com, a new interactive database for the best practice of evidence based medicine