Hypertensive labeling


Dear Sir: I very much appreciate Professor Per Lund-Johansen's comments. I feel at home with most of the statements. I am, however, glad to rise to the occasion and to reply to Professor Lund-Johansen's specific commerits on several aspects of hypertensive labeling. First of all, in his opening statement he ended up with the remark, "Birkenh~ger gives no clear answer." Far from resenting that remark, I consider it as a compliment in disguise, for the simple reason that it was my intention to point out the current problems and fallacies, ra ther than to provide "clear answers" on the basis of the current murky data bank. I strongly object to the te rm white-coat hypertension for the situation that arises from hypertensive labeling. Far from being a simile, this is an outright misnomer. White-coat hypertension (the late Sir George Pickering liked to dub this the "curiosity reflex") is an acute, ephemeral phenomenon, strictly related to the transient event of having one's blood pressure measured by an outsider, white coated or not. Automatic recordings have demonstrated that after the exit of the measurer, blood pressure promptly reverts to habitual levels. By contrast, the sequelae of true hypertensive labeling are pervasive and chronic (as demonstrated by the Oslo Group), and may include illness at the worksite. Let us hope that this misunderstanding of terminology will be eliminated on the spot, because the issue is already confusing enough as it is. I fail to understand why in young borderline hypertensives any consideration of additional risk indicators should deviate the doctor from the general aim of guiding the young "patient" away from his potential distant fate. I am not sure how to deal with Professor LundJohansen's ra ther ambivalent s tatement regarding the "awareness bias" in hemodynamic and other investigational procedures in early hypertensive subjects. He seems to recognize that in general it has been virtually impossible to avoid informing study subjects about their blood pressure status, so I cannot detect much controversy here. Let me just add that over the years I have interviewed quite a number of investigators on this aspect in their series, and I feel confident that I have gathered sufficient confirmation in this regard. My cogitations on a possible pharmacological remedy for the unwanted effects of hypertensive labeling were chiefly inspired by the fact that I was writing an editorial in a pharmacologically oriented journal. I hoped to provoke a discussion, which [ apparently did. This serves to clarify my speculations on using a betablocker. I should have stressed that I merely considered the use of a low (palliative ra ther than antihypertensive) dose in order to alleviate some of the most onerous sensations ("cardiac awareness" in general, and palpitations in particular). Such an approach would obviate a "profound effect" on hemodynamics. I am pleased to have been offered the opportunity to elaborate on this point. I may repeat that on balance I tend to reject any pharmacological approach in view of its potential reinforcement of the hypertension stigma. As to Prof. Lund-Johansen's concluding paragraph, I venture to guess that all colleagues in our field will share such a view.

DOI: 10.1007/BF00877828

Cite this paper

@article{Birkenhger2004HypertensiveL, title={Hypertensive labeling}, author={PhD Willem H. Birkenh{\"a}ger}, journal={Cardiovascular Drugs and Therapy}, year={2004}, volume={7}, pages={729-729} }