Classical manuel bood pressure measurements must be banned by legistlations and ISH and WHO. A real Harakiri procedure and a combinational compilation of reverse white coat and physical exercise effects

Purpose: It is known some normals and hypertensive patients get higher blood pressure (BP) when they face medical environments or devices. This effect is called White Coat Effect or Hypertension. We examined if the same effect could be also found in medical staff in Outpatient Clinics. This is the first medical hypothesis on this subject.Material and methods: 58 doctors and nurses examined 12 hypertensive patients by measuring BP in person with classical manual blood pressure recorders , every 10 minutes for two hours first day, then they stayed calm and relaxed in the consecutive second day , again similarly for two hours,. Sistolic BP (SBP), diastolic BP (DBP), mean BP (MAP), heart rates (HR), two hours norepinephrine levels (NE), two hours-epinephrine levels (E), two hours-vanilil mandelic acid levels (VMA) and two hours-metanephrine levels in their urines and plasma NE levels, plasma E levels, plasma renin activity levels (PRA), plasma aldosteron levels, plasma angiotensin II levels (AT II) were all examined in the medical staff. Additionally plasma AT II levels were examined also just before the blood pressure recordings in the first stress day.Results: Blood pressure levels from the first day to the second decreased as expected from 127.5±10.9 mm Hg to112.5±11.5 mm Hg in SBP, from 78.3±8.2 mm Hg to 71.8±8.8 mm Hg in DBP, from 99.7±9.1 mm Hg to 89.6±9.8 mm Hg in MAP and so same from 88±9.9 to 76.4±10 beats in HR.The cathecolamin levels in two-hours urine outputs also decreased as expected from the first day to the second from 95.8±117.8 mikrogram/L to 59.2±105.5 mikrogram/L in NE values, from 18.6±19.2 mikrogram/L to 6.1±4.7 mikrogram/L in E values, from 4.8±2.4 mg/L to 2.8±1.4 mg/L in VMA values and from 168.9±111.7 mikrogram/L to 100.7±49.6 mikrogram/L in metanephrine values.The blood cathecolamin levels also as expected decreased from the first day to the second from 561.5±444.2 ng/L to 347.7±343.3 ng/L in plasma NE values, from 99.2±104.1 ng/L to 62.8±67 ng/L in plasma E values, from 37.8±19.8 mU/L to 25.9±13.9 mU/L in PRA values, from 100.7±51.7 pg/ml to 62.5±33.6 pg/ml in aldosteron values.But interestingly and unexpectedly plasma AII levels also decreased from the time of prerecordings of the bloood pressures at the beginning to the time of postrecordings of the blood pressures in the very first stres day as from 33.6±8.4 pmol/L to 20.5±9.1 pmol/L.Overhelmingly almost all the p values for the differences of the all procedures step by step were less than 0.001, except plasma E and AII levels of which also p value were less than 0.05 and AII levels of which p value was 0.35 but not significant at all in the study.Conclusion: We summarised that all medical personels as mentionned are having higher BP (SBP, DBP and MAP), HR and cathecolamins both in urines (NE, E, VMA and M) and in plasma (NE, E) and also higher levels in PRA and A during this compilation of emotional plus physical exercise tests in outpatients clinics while examinations. Surprisingly reduction of AT II levels at the time of postrecordings of blood pressure can be explained by AT II?s very short half life time in the blood as known (several seconds). If AT II levels could be examined continously durıng the blood pressure measurements, AT II levels could have been found pretty higher at the very first stages but would have been found decreasing tremendously by the time till the end-point.Those mentionned medical staff could face complications, such as cerebrovascular attacks, myocardial infarctions, blindness if they have hypertension or prone to it. Manual BP procedures for those personel was kind of a reverse white coat effect plus a hand-grip-exercise test and could be dangerous. In developping countries where 150-200 patients are examined and BP are recorded daily only by one doctor, such manual recorders must be banned by legistlations and started first in the medical history via ISH and WHO. This is a sine qua non humanity task. And additionally a small beta one blocker or imidazolin receptor agonist (such as atenolol 50 mg early in the morning and even 25 mg in the evening to prevent withdrawing or rilmenidin 1 mg morningly) should be given if they are prohypertensives or hypertensives as in Stage-Fright Disease or before Airflights.Keywords: Blood pressure measurement, Sympathetic nervous system, Cathecolamins, White coat hypertension, White coat effect; Emotional hypertension, Physical exercises hypertension