white coat hypertension, blood pressure, blood pressure measurement, blood pressure and dementia

White coat hypertension, a condition in which blood pressure is elevated at the doctor’s office or clinic but not at home, is a fairly common condition. Sometimes it can result in people taking medication they may not need. Some of our readers have suggested that simply getting to the doctor might be enough in some cases to make blood pressure spike. Does that happen to you?

How Could Getting to the Doctor Affect Blood Pressure?

Q. I have found that blood pressure measurements are usually taken soon after you arrive at the doctor’s office. Part of white coat hypertension could be that you’re stressed from getting to the office (finding parking, walking, filling out forms). Taking the blood pressure later in the visit might provide a more useful reading.

Getting to the Doctor Early:

A. Thanks for this advice. Another reader shared her solution to this challenge:

“I resolved my white coat hypertension by arriving well ahead of my appointment. I get a coffee and then have time to sit and relax a little with my iPad or a magazine. This gives me a chance to recover from the stress of heavy traffic so I can avoid the anxiety of being late.”

We are glad this works for you. For others, we would discourage the coffee. Some research suggests that drinking coffee can increase blood pressure for a few hours (Clinical Nutrition, online, March 31, 2016). While that is not enough to be a problem long-term, it could certainly affect blood pressure measurement in the office.

There is not currently consensus among physicians about how white coat hypertension should be treated (Current Hypertension Reports, Nov., 2016). People with this condition seem to be at intermediate risk-right in between those with unquestioned high blood pressure, which increases the risk of heart attacks and strokes among other dangers, and those with normal blood pressure that doesn’t need any treatment. People who do have elevated blood pressure only at the clinic should probably stay in touch with the health care provider for regular monitoring. That way, if occasional high blood pressure becomes more frequent, someone will note it and initiate treatment.

Measuring Blood Pressure Properly:

Even if the stress and hassle of getting to the doctor doesn’t mess up your blood pressure noticeably, it is still important for it to be measured properly. That means:

  • Sitting on a chair with back support,
  • with your feet on the floor, not dangling
  • with your arm supported at heart level
  • and not talking.

It is surprising how frequently these basics of blood pressure measurement are overlooked or ignored. In addition, the blood pressure cuff needs to be the correct size. People with unusually thick arms need a larger cuff; those with extremely thin arms may need a smaller cuff than normal.

Masked Hypertension:

There is a condition that is the counterpoint to white coat hypertension. In masked hypertension, blood pressure measurements may be normal at the doctor’s office, but is often elevated in other situations. This condition can be difficult to diagnose, but it affects between 10 and 15 percent of the population (Circulation, Dec. 6, 2016; European Heart Journal, online Nov. 10, 2016). That is why we urge everyone to have a home blood pressure monitor and use it regularly.

You can learn more about white coat hypertension and blood pressure control, as well as guidelines on proper measurement of blood pressure, in our Guide to Blood Pressure Treatment.

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  1. Rebecca
    Idaho
    Reply

    My mother’s doctor convinced her she had white coat hypertension. I believe as a consequence it was inadequately controlled and she was never treate appropriately for her cardic and stroke issues. I firmly believe this contributed to her death at 77.

  2. Tina
    Dallas
    Reply

    I agree with the cuff size making a difference. Sometimes the cuff gets so tight on my arm, it really hurts. I would think that would make my blood pressure read high as it is painful! Even though I tell the nurse it hurts, they don’t do anything about it.

  3. Bob
    Bluffton, SC
    Reply

    To be honest with you I don’t know what my blood pressure is. I purchased a high end electronic BP monitor and it always displays the same oddities. The 1st reading is high, the 2nd is about 15 points lower, the 3rd a bit higher, the fourth lower yet. I go though all of the rest periods, am sitting, wait between readings, etc. but this doesn’t help with the inconsistencies. At the doctor’s office my readings would agree more with my 2nd reading or maybe even lower because they don’t allow you to rest but take your BP immediately after walking into the exam room. So the actual should even be lower and more consistent with my 4th readings.

    I called into a radio show from the Langone Medical Center in MYC and spoke with a nationally known heart specialist. He said you should “……never use the first reading when taking BP measurements………” I agree.

    I sent my unit back to the company for their evaluation and they indicated it was within a half unit of accuracy. So I’m confused as to what readings I should take/use.

  4. Patsy
    California
    Reply

    I always experience white coat syndrome, but only when I see my regular doctor. It never happens at the allergist’s office or anywhere else. Also, I have to chuckle at the advice for how to take blood pressure correctly. I am 4’11” short. It is impossible for me to lean back on a chair AND have my feet flat on the floor at the same time. It is an either/or proposition. Which is the best choice?

  5. Dave
    Reply

    I’ve found using the following technique while waiting to see the Doctor calms me and lowers my blood pressure.
    Sit straight up in a chair with your feet flat on the floor, take a deep breath slowly through your nose, hold it for several seconds and breath out slowly through your mouth. Ido it for around 5 mins.. After 5 to ten mins. if I haven’t seen the Doctor I repeat. I’ve also found it helps to keep me from getting upset when the wait is over long which I’m sure would raise my blood pressure as much as white coat hypertension.

  6. Sami
    PA
    Reply

    For me, I know it would be of GREAT help to anyone waiting for the Dr.’s office NOT to schedule 4-people for the same time!! Most wait time in a Dr.’s office is 1-hour ~ then they call you back and you wait another 15-30 minutes to see the Dr.

  7. Cara
    Coupeville
    Reply

    I have terrible PTSD because of the way I have been treated by medical personnel for most of my life. My current MD has the staff take blood pressure as soon as you enter the examine room. They do not take it correctly per the AMA guidelines. There is always a difference of between fifty to seventy points from what I get and from what they get. My PTSD is so bad, that I have on one occasion been paralized when I got out of the car in the parking lot. I take my b.p. every day, keep a record of it and bring it in, when I have to see my doctor. Frankly I would be the happiest person in this world if I never had to see another one. Far too many sadists and downright perverts are in that profession, and they get by with it.

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