What Is White Coat Hypertension?

Why Blood Pressure Measurements May be Falsely Elevated in the Doctor's Office

A blood pressure cuff at a doctor’s office.
A blood pressure cuff at a doctor’s office. Fuse/Getty Images

It is common for some people to have high blood pressure readings only while at their doctor's office or the hospital, but not at home. While high blood pressure readings can be the first sign of prehypertension, it might also be a case of white coat hypertension.

What Is White Coat Hypertension?

White coat hypertension, also known as isolated office or clinic hypertension, is a common syndrome among people who feel anxious in medical settings.

White coat hypertension specifically refers to elevated blood pressure readings that occur only while at the doctor's office, meaning that the reading is not the same as it would have been if you took your reading somewhere more comfortable, say, at home. Surprisingly, your systolic number, the one on the top, can increase by as much as 30 mm Hg due to this syndrome.

Why Treatment Generally Isn't Necessary

Treatment with medication is usually not indicated for this condition. This is because studies have shown that the problem is both common (up to 20 percent of the population is affected) and tends to resolve on its own. Instead, your physician may decide to monitor your blood pressure more closely or suggest a home blood pressure monitor to ensure you are only hypertensive at the office.

If you're like the majority of patients with clinical hypertension, your blood pressure will spontaneously improve when you return to your typical environment.

Even better, most patients don't even show signs of this condition by their third visit to the doctor.

Sometimes it takes a little longer for this issue to resolve, so patients are usually given three visits before doctors start thinking about the possibility of beginning treatment.

Risks Associated with White Coat Hypertension

Early research was positive and suggested that people with whitecoat hypertension were not at any increased risk of cardiovascular mortality (death from heart or circulation problems) compared to people with normal blood pressure.

In contrast, recent studies have shown that people afflicted with this type of hypertension have higher incidences of stroke and organ damage, as well as heart attack and heart failure. These folks also face an increased risk of developing persistent high blood pressure or exhibiting certain negative cardiovascular traits associated with high blood pressure.

Causes of Isolated Office Hypertension

Why do people experience white coat hypertension? According to a review from the Journal of Psychology Research and Behavior Management, the likely answer is the anxiety you feel when you are at the doctor's office causes the high blood pressure. That's why when you go home, it returns to normal.

The researchers found reducing your anxiety at the doctor's office could be as easy as improving the relationship between you and your health care provider. They suggest doctors should improve the quality of their interaction with you through effective communication, taking the time to express empathy and building trust.

White Coat Hypertension Versus Masked Hypertension

A number of patients actually suffer from a condition called masked hypertension. The reverse of whitecoat hypertension, these folks have normal blood pressure readings at their physicians office and high blood pressure at home.

What causes masked hypertension? The answer is likely stress at home or not taking medicine consistently and then starting to take it when you realize you have an upcoming doctor's appointment. Masked high blood pressure is also associated with negative health outcomes, including an increase in cardiovascular events.

Sources:

Celis, et al. White-Coat Hypertension: A Clinical Review. European Journal of Internal Medicine (2004).

Chobanian, et al., The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report. JAMA, 289(19)2560-72, 2003.

Cobos, et al. White Coat Hypertension: Improving the Patient-Health Care Practitioner Relationship (2015)

Khattar, et al., Cardiovascular outcome in white-coat versus sustained mild hypertension: a 10-year follow-up study. Circulation, 98(18)1892-7, 1998.

Verdecchia, et al., Short and Longterm Incidence of Stroke in Whitecoast Hypertension. Hypertension, 45(2)203-8, 2005.

Bidlingmeyer, et al., Isolated Office Hypertension: A Prehypertensive State? Journal of Hypertension, 14(3)327-32, 1996.

Palatini, et al., Target Organ Damage in Stage I Hypertensive Subjects with Whitecoat and Sustained Hypertension: Results from the HARVEST Study. Hypertension, 31(1)57-63, 1998.

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