PHILADELPHIA – White coat hypertension, a condition in which a patient's blood pressure readings are higher when taken at the doctor's office compared to other settings, was originally attributed to the anxiety patients might experience during medical appointments.
Recently, WCH has been found to increase the relative risk of sustained hypertension by almost three-fold when compared with patients with normal BP
Some people find that their blood pressure is normal at home, but rises slightly when they’re at the doctor. This is known as white coat syndrome, or the white coat effect. The syndrome gets its name from doctors and medical staff who sometimes wear white coats in a professional setting.
A healthy blood pressure reading is around 120/80 mm Hg. Anything above this is considered high blood pressure.
White coat syndrome may make your blood pressure read higher than it normally is, and the effect isn’t always a minor issue of doctor-associated anxiety. For some people, white coat syndrome could be a sign of a more serious blood pressure condition.
White coat hypertension vs. hypertension
White coat hypertension is high blood pressure that occurs at your doctor’s office or in a medical setting, but not in other settings. Regular hypertension is high blood pressure that occurs in many scenarios, not just a medical one.
Among those with high blood pressure at the doctor’s office, 15 to 30 percent of them may actually have white coat hypertension. Experiencing the white coat effect doesn’t mean you have more general hypertension.
Likewise, some people with hypertension don’t always experience high blood pressure at the doctor’s office.
This second condition is called masked hypertension. It occurs when your blood pressure reading is within a normal range at your doctor’s office but is higher in other settings.
It’s not uncommon for people to experience a bit of anxiety when they visit a medical office. This increased anxiety can ratchet up your blood pressure numbers.
White coat hypertension causes temporary increases in your blood pressure. While it might not seem serious if it occurs only occasionally, some doctors believe white coat hypertension could be a forerunner of real hypertension. In fact, one study found that people with white coat hypertension had an increased risk of:
- heart attack
- heart failure
- other cardiovascular conditions
Another study found that death from heart disease was strongly associated with white coat hypertension.
For these reasons, reaching a diagnosis and deciding if you need treatment for your elevated blood pressure is important.
Other causes for hypertension
A doctor in a white coat isn’t the only cause for occasional hypertension. Some people experience moments of increased blood pressure because of other stressors, like work, an emergency, or not taking your blood pressure medicine for several days.
Eating food that’s high in sodium or consuming a lot of caffeine might also temporarily increase your blood pressure.
While your blood pressure might return to normal once the trigger is removed, the increase in blood pressure can still be cause for concern. The temporary increase in blood pressure, whether it’s from a doctor or another cause, can cause strain and damage to your heart. If this temporary increase in blood pressure occurs for a long period of time, the damage can become more severe.
Overcoming white coat syndrome
Knowing that your blood pressure might climb higher in your doctor’s office may actually become a self-fulfilling prophecy for some. In other words, the worry that you’ll have a high blood pressure reading may actually cause just enough anxiety to boost your blood pressure.
Before you strap on the blood pressure cuff, keep these tips in mind for a normal reading:
If you’re feeling anxious or worried when you sit down to have your blood pressure measured, ask the doctor or nurse to wait a bit so you can calm down.
Move to a different area
Sometimes the triage areas of doctor’s offices are crowded with people and office staff. Ask if you can move to a quiet area away from everyone else so you can get a more accurate measurement.
Practice stress relief
Find a technique that helps you calm down when you’re anxious or stressed. For example, breathe deeply and exhale slowly. Try a few of these breaths before your blood pressure reading. Reciting a poem or verse in your mind may help you relax, too.
Change the conversation
Talking while having your blood pressure taken can help distract you from the test and improve your reading. For others, however, sitting quietly without talking may be more relaxing. Try different methods to see which works for you.
How is hypertension diagnosed?
If you have a high blood pressure reading, your doctor may ask you to come back to check your blood pressure again over the course of a few weeks or months. However, you may experience white coat hypertension again.
In order to avoid this, your doctor may suggest you take blood pressure readings away from the doctor’s office. For that, you have two options.
First, you can purchase a home blood pressure monitor. Visit a medical supply company or pharmacy and ask for assistance finding the correct machine and a proper cuff. Ill-fitting cuffs can cause improper blood pressure readings. With this machine, you can take regular readings and record them for your doctor. Here are some tips for taking your blood pressure at home.
The second option is an ambulatory blood pressure monitor. This device is strapped to you and worn for 24 to 48 hours. It tracks your blood pressure every 20 to 30 minutes during the window of monitoring.
Both of these tests can help your doctor see how your blood pressure responds to the activities of your day. The ambulatory blood pressure monitor may be preferred because it can take readings during activities, like exercise and sleep.
One study found no difference between the two devices when it comes to accuracy.
If your blood pressure is still high after relaxing, talk with your doctor about your options. Most doctors won’t make a high blood pressure diagnosis off one high reading.
Prescribing a medication for hypertension off one elevated blood pressure reading may lead to serious issues, including hypotension. Hypotension occurs when your blood pressure drops too low. You may feel weak, dizzy, or even pass out from low blood pressure.
Instead of making a diagnosis, your doctor may ask you to return again several times over the next few weeks to monitor your numbers. Of course, this can make the white coat effect appear again. That’s when you should talk with your doctor about other blood pressure monitoring options.
A visit to the doctor’s office may cause a temporary increase in your blood pressure. It’s not always a sign of a bigger problem, but it’s worth monitoring.
Over time, temporary increases in blood pressure, both at your doctor’s office or at other times, can damage your heart. This may increase your risk for more serious conditions.
If you’re worried about your blood pressure numbers, talk with your doctor. Together, the two of you can find a diagnosis and decide on the best way to treat it.