Only at the Doctor's Office: High Blood Pressure and White Coat Syndrome

Does the site of your doctor spike your blood pressure? You could have white coat hypertension. This is blood pressure that seems elevated only when measured in the doctor's office.

• On one extreme, it could lead to the unnecessary prescribing of high blood pressure medications. Your doctor may think you have chronic high blood pressure when you don't.
• On the other extreme, it could be dismissed as anxiety when in fact it might be a sign of an underlying blood pressure problem.

It's likely that the real problem is somewhere in the middle. If your blood pressure reacts to the stress of a doctor's appointment, it probably goes up at other stressful times during the day, too. And, in the end, increases in blood pressure (whatever the cause) can damage blood vessels.

Medical experts debate the cause of white coat hypertension. Is it simply a temporary case of nerves? Or does it signal an underlying blood pressure regulation problem that could lead to hypertension and - in time - heart disease? It's also unclear whether or not it should be treated. The only sure way to find out if your high blood pressure is purely "white coat" is to monitor it over 24 hours with a special blood pressure monitoring device.

How can you find out your true blood pressure measurement?
Even if you really do have high blood pressure, you usually won't have symptoms unless it has already caused damage, such as a heart attack or stroke. That's why high blood pressure is sometimes called the "silent killer."

There are a number of ways to test whether your high blood pressure may be simply a result of the white coat effect. Your doctor may:

• Check your blood pressure at the start of the appointment and then again at the end.
• Ask you to measure your blood pressure with a home monitor. Ask your doctor what kind of blood pressure cuff to get and how often you should take readings. Your doctor or pharmacist can show you how to use the monitor and check it from time to time to make sure it works right. Then make a log of your testing results to share with your doctor.
• Recommend ambulatory blood pressure monitoring. Your doctor may ask you to wear a small, portable monitor that automatically takes blood pressure readings every 15 to 30 minutes throughout the day and night. He or she can then look at these readings to see what your blood pressure is when you are not in the office.

What should you do about white coat hypertension?
Studies have not given a clear answer. Some studies suggest that having white coat hypertension may put people at greater risk for actual high blood pressure, heart attack or stroke. Others have not found this to be the case. If you have white coat hypertension, your doctor will decide if you need to take medicine for it. Part of the decision depends on your risk factors and general health.

Either way, you can take steps to reduce your risk for heart disease. You should follow a heart-healthy diet and lifestyle. This includes eating a low-fat, low-sodium diet and getting regular exercise, with your doctor's approval. It's important to regularly check your blood pressure and see your doctor.

Related Articles A Quick and Realistic Look At High Blood Pressure Blood Pressure Monitoring

External Sources American Heart Association. Common misconceptions. Accessed December 17, 2007. American Heart Association. Home monitoring of high blood pressure. Accessed December 17, 2007. National Heart, Lung and Blood Institute. High blood pressure. Accessed December 17, 2007. Victor RG, Kaplan NM. Systemic hypertension: mechanisms and diagnosis. In Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed. 2007. Accessed December 17, 2007. Ohkubo T, Kiyuka M, Metoki H, et al. Prognosis of

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