Dangers of White Coat Hypertension for Patients

This form of high blood pressure shouldn't be ignored

Hands checking patient's blood pressure
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Picture this common scenario: you check your calendar and see that today is the day of your doctor's appointment and your blood pressure rises at the thought. You experience what's called white coat hypertension, or white coat syndrome.

Before today, you were calm and your blood pressure at home had been excellent. You find yourself worrying about your appointment. You arrive the doctor's office, get checked in and sit in the waiting room for an hour (which causes even more anxiety).

You are then hurried back to the examination room; your blood pressure level is checked as soon as you sit down. You are then told that your blood pressure is "high". 

You tell the doctor, "My blood pressure at home is usually good." You have a home record of your blood pressure that reflects "normal" results. Does this sound like your experience at the doctor's office?

Defining White Coat Hypertension 

White coat hypertension (WCH) has been traditionally defined as blood pressure that is elevated at the doctor's office while being normal at home. The original thinking was that white coat hypertension was not dangerous as it reflected blood pressure at one point in time. Further research noted that it increased the risk of stroke and developing high blood pressure. 

Today we know white coat hypertension is a sign of how your body reacts to stress and anxiety during the day. If your blood pressure goes through the roof when you are at the doctor's office, it is highly probable that it also skyrockets during other highly stressful events.

During these "episodes" your body is producing blood pressure hormones like cortisol, epinephrine and norepinephrine that raise your blood pressure, increase your heart rate and "prep" your body as if it was going into "fight or flight" mode. For many of us, this may happen several times a day outside of the doctor's office, and we almost never record our blood pressure during these stressful events.

WCH increases the risk of stroke, high blood pressure, heart disease and even congestive heart failure.

Blood Pressure While You're Asleep

The other question is: What is your blood pressure doing when you are sleeping? It may be that your blood pressure also rises at night when you are sleeping, that your blood pressure may not "dip" at night when you go to sleep as it is supposed to. When you sleep, your blood pressure should decrease. It may be that white coat hypertension decreases  this nocturnal dipping response in some people. Those with WCH may have a more sensitized endocrine system (they are more apt to secrete higher amounts of high blood pressure types of hormones in times of stress). 

The Best Way to Manage White Coat Hypertension

If you have been diagnosed with white coat hypertension, you need to know what your blood pressure is doing 24 hours a day. This means knowing what your blood pressure is doing when you're relaxed, when you're stressed and when you are sleeping. You need to have ambulatory blood pressure monitoring done.  

You need to learn techniques for stress management. Taking time out during the day, yoga and meditation all help to reduce stress and to keep your blood pressure stable.

It also helps to reduce or eliminate your caffeine intake and correct any nutritional deficiencies, including normalizing magnesium levels and increasing your consumption of fruits and vegetables (which provide great antioxidant value).

Finally, when you go to the doctor, be sure that you are sitting for about 10 minutes before your blood pressure is taken. You want to be sure that a true "resting blood pressure" is measured. Normally, the blood pressure is taken by the nurse or medical assistant right after walking you back to the examination room. This is a common occurrence and you should consider asking your doctor to take a second "resting" blood pressure measurement.

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