Medical students can cause blood pressure to rise, report says

A new study has shown that the presence of a medical student can increase blood pressure when measured in general practice. The researchers found that blood pressure was significantly higher in consultations where measurements were taken in the presence of a medical student or trainee than in consultations where no student was present. “If confirmed, our findings imply that doctors should be cautious to initiate or adjust antihypertensive drug treatment when blood pressure readings are obtained in the presence of a trainee,” say the researchers in their report (Journal of Human Hypertension 2004;18:769-73). In the study the researchers, from Ghent University, Belgium, recruited nearly 300 patients with normal or high blood pressure from 22 general practices affiliated to the university. They tested the hypothesis that the presence of a final year medical student can increase patients' blood pressure, above any increase caused by the presence of the doctor. They randomised the patients into a trainee group and a no trainee group, and blood pressure was measured at two consultations. In the trainee group a student was present only at the first visit. At the first consultation blood pressure averaged 139.5/80.2 mm Hg in the trainee group and 133.1/77.8 mm Hg in the no trainee group. At the second consultation systolic blood pressure was lower by 4.8 mm Hg and diastolic lower by 1.7 mm Hg diastolic in the trainee group, while in the no trainee group systolic pressure was 0.1 mm Hg higher and diastolic pressure was 1.5 mm Hg lower. Thus the average between group differences averaged 4.7 mm Hg systolic pressure (95% confidence interval 1.5 to 7.9 mm Hg; P=0.005) and 3.2 mm Hg diastolic pressure (1.1 to 5.3 mm Hg; P=0.003). • White coat hypertension (the phenomenon by which the blood pressure of some patients is higher when measured by a doctor than when recorded by continuous monitoring or other measurements) should not be treated as harmless, say researchers in another study published in the Journal of Human Hypertension (2004;18:809-14), who say it has common features with sustained high blood pressure. Patients with sustained high blood pressure are at risk of cardiovascular complications, possibly related to endothelial damage or abnormal angiogenesis. The aim of the study was to compare the risks of white coat hypertension and sustained hypertension in the development of endothelial dysfunction and abnormal angiogenesis. A number of markers were measured, including concentrations of vascular endothelial growth factor. The researchers looked at three groups of patients: those with white coat hypertension, hypertensive patients, and those with normal blood pressure. Patients in the white coat hypertension group were found to have significantly higher concentrations of vascular endothelial growth factor than patients in the normal blood pressure group, but the difference from the hypertensive group was not significant. “The increasing level of VEGF [vascular endothelial growth factor] emphasises the presence of abnormal angiogenesis in WCH [white coat hypertension]. Our data demonstrate that WCH is associated with endothelial dysfunction and abnormal angiogenesis. The degree of these changes is not as severe as observed in hypertensive population. The presence of endothelial dysfunction and abnormal angiogenesis suggests that WCH has common features with sustained hypertension and should not be considered as a harmless trait,” write the authors.