The Different Manifestations Of Hypertension

Well, Blood Pressure (BP) medicines are not like antibiotics, one should not stop the medicines unless advised by the doctors. That may be quite old news for you but what is new is that many are not aware about the various ways hypertension can manifest.

Let's have a look at some of these innovative ways hypertension can appear in a patient and who else can better explain these subtle changes than Dr. C. Venkata S. Ram, Director, Apollo Institute for Blood Pressure Management & Director, South Asia Region - World Hypertension League (in partnership with WHO).

Secondary Hypertension:

In some patients, BP is known to shoot up due to "secondary" factors such as thyroid gland disease, adrenal gland problems, blockage of circulation to the kidney, certain kidney ailments, heavy snoring/ sleep apnea, excessive alcohol use or pregnancy.

The rule is simple for a doctor: If the secondary case for hypertension is diagnosed by the doctor, the problem can be solved and the patient's BP will become normal. So, a doctor has just to suspect it before it can be fixed.

But the million dollar question is how does a health care practitioner detect the possibility of an underlying secondary hypertension in a patient?

"In young people, we detect high BP by doing tests for potassium, sodium, creatinine for kidney function, CT angiogram for blood supply to the kidney besides checking their thyroid and adrenal glands," said Dr. C. Venkata S. Ram, Director, Apollo Institute for Blood Pressure Management.

White Coat Hypertension: 

The other ways high BP can manifest in a patient is a little weird on the face of it. Known as White Coat Hypertension, here the blood pressure in a patient goes up only in the doctor’s office or hospital, but is normal outside when at home or workplacce.

Hence, for a health care practitioner it is essential that make their patients at ease when they step into their hospital for the first time. The serious look on the face of the doctor may actually trigger White Coat Hypertension as nervous individuals and “tense” people are often known to suffer from this problem.

But is it serious? What if you have White Coat Hypertension but you take it casually? What will happen? We again ask the expert and get these queries answered for the lay people out there.

"About half the number of people with white coat hypertension will develop regular hypertension and the other half will become normal BP," said Dr. C. Venkata S. Ram, Director, Apollo Institute for Blood Pressure Management.

This sounds serious but reasons are not too difficult to understand as even those with white coat hypertension take it lightly and do not do necessary follow-up with disastrous consequences.


"Even though IT people are considered smart but many aren't but I can't follow them. I ask them to come after three months, but they cite emergency transfers to Gurgaon, Bengaluru, Pune or Nasik (and delay treatment). The only way to find that white coat hypertension has not turned into regular high BP, one has to follow up," he said.

Reverse white coat hypertension:

In some others, the blood pressure is normal in the doctor’s clinic or hospital but is high outside (at home or work). This is called “reverse” white coat hypertension or “masked” hypertension. We can diagnose these abnormal condition by measuring 24 hr blood pressure (at home or work) with an automatic machine. This was the most important thing to ask the expert as lay people are unsure as to when to start monitoring their BP regularly? In teen or adult age or after marriage?

Right time to measure BP:


"My personal view is that the right time to monitor one's BP is from High school onwards atleast once in a year. You have time for cinema, Lumbini park and paani puri, can't you spare two minutes for BP," asked Dr. C. Venkata S. Ram, Director, Apollo Institute for Blood Pressure Management.

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