Association of thyroid function with white coat hypertension and sustained hypertension

[helvella]

Yet another paper that associates thyroid issues with the heart. It isn't that long ago that 'white coat hypertension' was coined! And here we are with a possible contributory factor.

J Clin Hypertens (Greenwich). 2019 Apr 11. doi: 10.1111/jch.13536. [Epub ahead of print]

Association of thyroid function with white coat hypertension and sustained hypertension.

Cai P1, Peng Y1, Chen Y1, Li L1, Chu W1, Wang Y2, Wang X1.

Author information

1 Department of Cardiology, Institute of Field Surgery, Daping Hospital, Army Military Medical University, Chongqing, China.

2 Key Laboratory of Basic Pharmacology of Ministry of Education Joint International Research Laboratory of Ministry Education, Zunyi Medical University, Zunyi, China.

Abstract

This study aimed to explore the relationship of thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) levels with hypertension subtypes. 1056 euthyroid adults were included as research samples. They underwent measurement of clinic blood pressure and 24-hours ambulatory blood pressure monitoring. Then, they were divided into normotension (NT), white coat hypertension (WCH), masked hypertension (MHT), and sustained hypertension (SHT) groups. The 24-hours dynamic electrocardiogram was performed to analyze the heart rate variability (HRV), so as to reflect the cardiac autonomic function. The relationship between hypertension subtypes, thyroid function, and HRV was analyzed. The TSH concentration was significantly higher in the SHT group than in the NT group (P = 0.001). The FT3 concentration was higher in the SHT group than in the NT and MHT groups (P = 0.013, P = 0.008), while the FT4 concentration was significantly higher in the WCH group than in the NT group (P = 0.002). The changes in HRV were observed between the SHT, WCH, and MHT groups and the NT groups, as well as between the SHT and the MHT groups. The multiple linear regression analysis also showed that FT3, HRV (RMSSD and PNN50), and blood pressure levels linearly correlated with one another (P < 0.05). Meanwhile, the linear regression analysis showed a linear negative correlation between FT4 and HRV (SDANN) in the WCH + NT group (P = 0.001). Thyroid function was closely related to hypertension subtypes such as WCH probably due to the changes in the cardiac autonomic function.

©2019 Wiley Periodicals, Inc.

KEYWORDS:

masked hypertension; sustained hypertension; thyroid function; thyroid-stimulating hormone; white coat hypertension

PMID: 30973206

DOI: 10.1111/jch.13536

ncbi.nlm.nih.gov/pubmed/309...

White coat hypertension occurs when the blood pressure readings at your doctor's office are higher than they are in other settings, such as your home. It's called white coat hypertension because the health care professionals who measure your blood pressure sometimes wear white coats.

mayoclinic.org/diseases-con...

[asiatic]

Thanks for posting this. It is of interest to me as I have been treated for 50 years for high BP and only recently proved what i had long suspected by home monitoring that I average 115/75 at home and 180 /95 in the surgery.I have Graves and was told by an endo I had relapsed as my pulse was nearly 100. He wouldn't believe me that it would go down to 65 five minutes after leaving him.

I am having difficulty following the conclusions in the paper. Are they saying in people like me with WCS blood pressure increases as fT4 decreases ? It is late perhaps I'll reread it in the morning!

[linda96]

I go to several hospitals for different medical issues. I was told that the newer automatic blood pressure machines are not accurate so to insist the nurses take blood pressure the ‘old way’. Yes, the readings are lower.

Also I’m called in immediately I arrive at hospital after travelling through a busy city centre to have readings done, but then sit half hour or so while waiting to see the dr. Yes readings are higher. I now politely ask ‘to get my breath’ and yes waiting a while settles the BP readings.

[G2G2]

I've repeatedly asked the nurse not to ask me questions while taking BP because it raises blood pressure.

[helvella Administrator in reply to G2G2]

Quite right too. If nurse and doctor training doesn't teach them that the patient speaking affects blood pressure, I despair of those doing the training. If they are asking questions, you will be preparing answers - which seems to be at the root of the issue.

Isr J Med Sci. 1982 May;18(5):575-9.

Blood pressure changes while talking.

Lynch JJ, Thomas SA, Long JM, Malinow KL, Friedmann E, Katcher AH.

Abstract

Using a noninvasive automatic device to rapidly and repeatedly measure blood pressure, a striking relationship was found between talking and an increase in blood pressure and heart rate. This finding was demonstrated in a variety of experimental settings (the laboratory, medical clinic, classroom and home) in both children and adults and in both normotensive and hypertensive individuals. A significant positive correlation was also observed between the level of resting pressure and the magnitude of increase in pressure while talking. These findings point toward an important link between human communication and blood pressure control that has previously been overlooked. They also suggest a new conceptual approach to the understanding and treatment of hypertension.

PMID: 7096040

ncbi.nlm.nih.gov/pubmed/709...

[G2G2 in reply to helvella]

Thanks. Think I should print that out for the nurse. Well, if she can read. No doubt my annoyance at her isn't helping BP either.

[Aurealis in reply to G2G2]

Yes questions raise mine too

[crimple]

I was told by practice nurse I was hypertensive and needed medication (normal BP about 116/78). At the time she had tried to give me a flu vaccine that I didn't want and she also suggested I needed statins, result BP of 143/95! I took my own readings at home for a week and average was 116/76 So no flu vaccine, no statins and no BP pills. Saved the NHS a fortune! Paying for my own T3 too.

[AnneEvo in reply to crimple]

I read an article 2 days ago which studied 165,000 people. The conclusion was that statins worked for only 1 in 2 people.

[crimple in reply to AnneEvo]

Yes, It was mentioned on the news. I was given statins by a locum instead of Thyroxine!!!!! Went back after I thought I was going to die (had taken just 4 days worth of the damned things) and saw my normal GP who when he saw my blood results put me straight on thyroxine. He managed me well for 5 year and then we moved, 3 years of hell made worse by raised antibodies. Now taking some T3 which I pay for myself via a private prescription from new GP. I but the T3 for £50 in germany, would cost me £1000 here!!

[AnneEvo in reply to crimple]

What a nightmare 😯

[Aurealis]

I can’t separate my raised blood pressure in GP office from the numerous combative conversations about dose and the causes of my symptoms. I doubt my WCH is anything more than a learned response to what is effectively repetitive harassment by GP

[LAHs]

Oh my gosh, this is exactly what I have been battling for the past 6 months! I did have slight hypertension (BP) of 140/60 and since losing weight didn't really do it I went to my (OK) doc and asked for something relatively safe to reduce my BP. So you can guess what happened, when I had my BP measured in his office I was measuring 170/x (x = don't care) and higher. (It was 202/x in the dentist!) He put me on one pill of Lisinopril (10mg) per day and while it did work I started to measure 110/x and could not really function. It was a bit like trying to run your car on a 6 volt battery instead of the needed 9 volt battery. I went back as instructed to see how I was getting along and I measured 179/x and so my dose was upped to 2 pills per day. Well that lasted 2 days and I dropped back to 1 pill for another couple of days and then reduced to 1/2 a pill - and that is what I have been taking now for about a month now. I told him what I had done and that 1/2 a pill keeps me at about 124/x and that is my operating pressure.His nurse gives me hell and berates me for not obeying the doctors orders - which of course sends my BP up since I am not a fighter/arguer. Geez you have to take care of everything these days. I've managed thyroids but hearts and vascular systems are not really my subject - but you still have to DIY and learn so that some idiot doesn't inadvertently kill you.

[Aurealis in reply to LAHs]

Yes with everything - Dr Google

When a family member had a stroke I learned from google that there was such a thing as a stroke ward, that a scan should have been done, that compression stockings were necessary. Nothing was done until I started asking Dr Google questions.

So, we had an NHS, in practice I’ve never been it’s greatest fan, though in principle I agree wholeheartedly with its existence. It just never seems to live up to expectations when you need it to. Still, it’s disappearing now, but no one is admitting that, so therefore there’s nothing in it’s place either. I fear for the future as well as for the present.

[lady_eve]

This is interesting. The last time I had my blood pressure checked it was high, for the first time in my life. The nurse attributed it to 'white coat syndrome' (as she called it) at the time. I'm definitely going to read this article with interest. Thank you.