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Potential Sign For The Future
Although white coat hypertension may be confined to the medical office, physicians must emphasize to patients that they cannot afford to dismiss it.
In a 1994 study in Circulation, Dr. Weber and his colleagues reported that patients with white coat hypertension demonstrated by ambulatory blood pressuring monitoring had early signs of changes in their hearts, kidneys and some hormone systems.
So even though they didn’t really have true hypertension, they only had white coat hypertension, they weren’t completely normal either, Dr. Weber said.
A subsequent 2005 study by Verdecchia and colleagues, published in Hypertension, suggested that the risk of stroke tended to rise long term in patients with white coat hypertension. In a 2005 editorial in Blood Pressure Monitoring, Verdecchia and Angeli also reported a higher risk of sustained hypertension in patients with white coat hypertension.
Physicians should explain the potential risks to patients and stress the importance of regular follow-up appointments to monitor their electrocardiogram, kidney function and blood sugar and monitor their blood pressure at home, particularly if they have a family history of hypertension.
Frequency of follow-up is a judgment call, Dr. Townsend said, and family history is an important risk modifier. He explained that yearly appointments are reasonable when a patient has white coat hypertension because a portion of these patients will go on to have sustained hypertension.
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Hypertension And White Coat Syndrome
A new definition was proposed by the American College of Cardiology and American Heart Association classifying hypertension for values of SBP 130 mmHg or DBP 80 mmHg. This modification relies on the fact that achieving these values is thought to prevent even more CVD.10 Nevertheless, the 2018 Guidelines of the European Society of Hypertension and European Society of Cardiology maintained the same definition of arterial hypertension as in the previous guideline 13 office values of SBP 140 mmHg and/or DBP 90 mmHg, arguing that the clinical studies analyzed provide data for the classification of BP and the definition of hypertension to remain unchanged in relation to previous ESH/ESC guidelines.14
One of the new recommendations in 2018 Guidelines for ESC/ESH was the wider use of outpatient BP measurements by ABPM and home blood pressure monitoring in order to diagnose phenomena related to white coat syndrome, which includes WCE, WCH, and MH.14 The steps for diagnosing each condition mentioned above are summarized in the flowchart of Figure 1.
Flowchart of the pathway to diagnosis/classify the white coat syndrome according to the BP levels.
Note: Steps for diagnosis of normotension, hypertension, and phenomena related to white coat syndrome.
Abbreviations: ABPM, ambulatory BP monitoring BP, blood pressure HBPM, home BP monitoring.
When To See A Doctor
No matter what causes it, high blood pressure increases the risk of developing medical complications like heart disease and stroke.
If youre concerned about your blood pressure, talk to your doctor, who can diagnose and treat you.
Likewise, speak to your doctor if youre struggling with anxiety.
Its normal to feel anxious from time to time, but if your worries interfere with your everyday life, treatment such as therapy, medication, or both can help you manage this anxiety.
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How To Overcome White Coat Hypertension
Does going to the doctor just seriously freak you out? Like to the point where your palms are sweaty and you can feel your heart racing, even though you know youre in great hands and likely dont have anything to be worrying about?
While we hate to hear that because weyour physiciansseriously want you to be comfortable, we can assure you that youre not alone and that what youre feeling when you step into our offices is more common than you might think.
In fact, that sudden rise in blood pressure you experience when you go to the doctor is so common, it actually has a name: White Coat Hypertension or White Coat Syndrome. Its an anxiety-induced blood pressure spike while in a medical environment when high blood pressure is not otherwise an issue for the patient.
Weve gathered some tips you can try to keep calm and overcome your White Coat Hypertension, but first, allow us to explain what it is, what could be causing the syndrome, and why it might be a bigger deal than you light think.
How To Get The Most Accurate Reading At The Doctors Office
Try to get the most accurate blood pressure readings possible. In addition to making regular appointments in your doctors office to get your blood pressure measured, talk to your doctor to see if home blood pressure monitoring would help clarify your diagnosis.
To get the most accurate reading in the doctors office, consider:
- Scheduling your appointment on a day when you will not be rushed
- Arrive a few minutes early to acclimate to the environment
- Ask to have your blood pressure taken in a quiet area
- Try deep breathing exercises before getting your blood pressure measured
Once you are on blood pressure medications, it will probably be lifelong. Taking steps now to fully understand your blood pressure status and learn how to manage it can help you avoid heart disease later in life.
Lifestyle changes such as smoking cessation, reducing alcohol intake, consuming a healthy diet, and adding physical activity as a part of your daily routine can help lower your blood pressure and decrease your risk of cardiovascular disease and stroke.
Leann Poston, MD, is a licensed physician in Ohio who holds an MBA and an M.Ed. She is a full-time medical communications writer and educator who researches and writes about medicine, education, and healthcare administration.
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Be Inspired To Do Something
You know your body better than anybody else. You probably know whether you have white coat syndrome.
If you believe your high blood pressure readings at the doctors may not be representative of your true readings, first notify your doctor of your suspicion and see if they suggest 24 hour ambulatory blood pressure monitoring.
If not, try a free automatic blood pressure machine at your local store. Or, preferably buy a blood pressure monitor for home-use and keep regular notes on your readings.
The only way to figure out if you have white coat hypertension is to have your blood pressure checked outside of the doctors office.
Keep a track of your numbers consistently. Yes, it might be a time commitment, but its important.
And, if you do have white coat syndrome, the good news is that you are not at increased risk of cardiovascular events. However, it does show that you may have an issue with reacting to stress. It may be an indication that you need to introduce stress management into your life.
Try one of my guided meditations on YouTube to start with.
Finally, join my free #generationcalm community, and get emails delivered direct to your inbox. Theyll help you with figuring out how to reduce your stress and anxiety naturally, so your mind and body feel great. Including information on stress management, one of the key ways to keep your blood pressure under control.
Like this post? Id love for you to follow me on and pin it for later!
How Do I Know If I Have White Coat Hypertension
There are no symptoms of white coat hypertension, you wont feel unwell if you have it. The only way to find out if you are affected is to have your blood pressure measured outside your doctors surgery or clinic. There are two ways of doing this:
Taking readings yourself at home and or Ambulatory Blood Pressure Measurement sometimes also called 24-hour monitoring.
A few people will be asked to have ABPM, which is a test to see what your blood pressure is like over a period of 24-hours. A small portable monitor takes readings regularly and automatically over a day and a night. Your doctor can then look at an average of the daytime readings and this should show whether you have a normal blood pressure at home. If the average reading is 135/85mmHg or less then it is normal. Some doctors surgeries now have ABPM equipment or alternatively you may need to go to your local hospital outpatients department to have the machine fitted.
You may also be asked to use an automatic or a semi-automatic blood pressure machine to take a series of readings yourself at home. Some doctors and clinics will lend you a monitor, usually for two weeks, and ask you to take readings at certain times of the day. After you have taken these readings your doctor or nurse will analyse them and work out an average. You can also buy machines to use at home, to monitor your blood pressure levels.
Will I need to be treated if I have white coat hypertension?
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What Is White Coat Syndrome
White coat syndrome is a condition in which your blood pressure is high at your healthcare providers office, but you get a normal reading at home. A normal blood pressure reading is less than 120 millimeters of mercury and less than 80 millimeters of mercury .
White coat hypertension is a concern because every year, 5% of people with white coat syndrome get a hypertension diagnosis.
An accurate blood pressure reading tells you whether you need treatment or not. If your reading isnt correct, you could be getting medicine you dont need or medicine thats too high of a dose. If your blood pressure reading is artificially high in the office, your provider may think your medicine isnt working.
Is white coat syndrome real?
Yes, white coat syndrome is real. Researchers have done multiple studies about it and documented their findings.
Is white coat syndrome dangerous?
It can be. People who have white coat syndrome may have blood pressure thats a little bit higher than those who dont have the syndrome. According to studies, high-risk people older than 60 may also have twice the risk of heart issues compared to low-risk people with this syndrome.
High-risk means they already had a heart attack or have diabetes or other risk factors. It may be these risk factors, and not white coat hypertension, that increases their risk.
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We Want To Do Something About It
Thrive Family Medicine was founded because we were frustrated, too. We believe in high-quality medical care in a friendly, welcoming atmosphere where our patients feel valued. You knowlike how every doctors office is supposed to be.
But we want to take the idea of humanizing healthcare even further. So our goal is to provide transparency, authenticity and a whole-life approach to healthcare including attention to diet, exercise, mental health and more.
If we sound like the kind of practice youd like to check out, wed love to hear from you. Isnt it time to schedule an appointment with doctors who care? Like, actually care?