Blood pressure rises and falls throughout the day in response to what a person is doing and what is happening around them. White coat hypertension (white coat syndrome, white coat effect) is a condition in which a patient develops high blood pressure (hypertension) when near a doctor (who often wears a white coat). The patient is nervous or anxious at the doctor’s office, causing the blood pressure to rise. The white coat effect is a temporary condition but does increase the risk of true hypertension (high blood pressure) with possible complications. A thorough diagnosis is essential to initiate any necessary treatment.

• Terminology of blood pressure condition
• Hypertension
• Causes of white coat syndrome
• Diagnosis and examinations
• Treatment of white coat effect
• Prognosis
• Complications of white coat hypertension
• Prevention of high blood pressure at the doctor

• Relaxation techniques
• Quiet space

Terminology of blood pressure condition

The white coat effect is not the same as masked hypertension. This is the opposite of white coat hypertension, because patients with this condition have a normal blood pressure reading at the doctor, but in reality (at home or elsewhere) suffer from high blood pressure. Both white coat syndrome and masked hypertension may lead to an incorrect diagnosis, resulting in incorrect drug treatment. Both conditions require frequent blood pressure measurements outside the doctor’s office or hospital.Smoking is a risk factor for hypertension / Source: Geralt, Pixabay

Hypertension

High blood pressure (hypertension) is a condition in which the force of the blood pushing against the walls of the blood vessels is too high. Normal blood pressure values average 120/80 millimeters of mercury (mmHg). Hypertension occurs when the blood pressure measurement is more than 140/90 mmHg. About one in three adults suffers from high blood pressure. Various risk factors increase the risk of hypertension such as:

• a family history of high blood pressure
• a lack of physical activity
• a kidney disease
• an older age
• a stressful lifestyle
• genetics
• excessive use of alcohol
• smoking
• thyroid disorders
• sleep apnea
• too much salt intake
• obesity

It is important to address these risk factors so that blood pressure remains within the healthy range.

Causes of white coat syndrome

With white coat syndrome, the patient only has high blood pressure when seen by the doctor or another healthcare provider. The patient may be nervous or anxious about the doctor’s visit. In approximately 15 to 30 percent of patients who present to the doctor with high blood pressure, it turns out that this is due to white coat syndrome. Some scientists report that white coat hypertension is a precursor to topical hypertension. Stress and anxiety play a role in the development of high blood pressure, so patients with white coat hypertension are at increased risk of complications of high blood pressure, such as cardiovascular disease. It is therefore important that doctors accurately diagnose a patient’s blood pressure and initiate any treatment as soon as possible.

Diagnosis and examinations

Diagnosing a patient with white coat hypertension poses a challenge for the physician because it is often difficult to get an accurate measurement. When the doctor receives a high blood pressure reading for the first time, he advises the patient to return a few weeks later for a new measurement. A patient with white coat hypertension is likely to have high blood pressure the second time around. The doctor then asks the patient to take the blood pressure measurements elsewhere using a home blood pressure monitor or an ambulatory blood pressure monitor. An ambulatory blood pressure monitor is a device that a patient usually carries with them at all times for one or two days. The device measures blood pressure at different times during the day. This makes it possible to measure blood pressure in a comfortable environment.

Treatment of white coat effect

Treating white coat hypertension is sometimes difficult, because it is difficult for doctors to get an accurate blood pressure measurement and therefore cannot immediately be certain whether the patient actually suffers from true hypertension or white coat hypertension. Normally, doctors do not prescribe chemical medications to treat a patient with high blood pressure based on one high reading. This quickly leads to hypotension (too low blood pressure), which also causes problems. The doctor must be sure, based on several measurements, that the blood pressure is too high due to white coat syndrome or true hypertension. A correct diagnosis is crucial to treat or prevent hypertension. If the blood pressure at home is also too high on several occasions, drug treatment for true hypertension will follow.

Prognosis

Managing stress and anxiety is beneficial to the patient because it increases the doctor’s ability to obtain accurate blood pressure readings. This temporary form of increased blood pressure is not entirely harmless as it is often a precursor to real hypertension.

Complications of white coat hypertension

The primary complication of white coat hypertension is hypertension itself. Many patients may think that fear of doctors causes their high blood pressure. However, the white coat effect may be an indication of future hypertension, which if left untreated may lead to cardiovascular diseases such as stroke, heart attack and heart failure (poor pumping of blood through the heart).

Prevention of high blood pressure at the doctor

Relaxation techniques

Some relaxation techniques, such as breathing exercises or meditation, are soothing for the patient. This calms him down just before he goes to the doctor. For example, the patient can also count three objects he sees in the consultation room, two things he can hear and one thing he can touch. When the patient practices this in the doctor’s office, he is distracted and less concerned about what is going on around him when measuring blood pressure. Taking a few deep breaths also helps to get the nerves under control.

Quiet space

If there are a lot of people in a consultation room or hospital, it can be intimidating for patients. A quiet or low-stimulus space reduces the risk of white coat syndrome.

read more

• Masked hypertension: High blood pressure at home, not at the doctor’s office
• Hypertension (increased blood pressure): Types and symptoms