Zombie, white coat hypertension

Physicians and nurses like to think of themselves as helpful healers. They have a hard time imagining that their mere presence can provoke anxiety. Data demonstrate, however, that some people react to a health care professional with a dramatic spike in blood pressure. This kind of reaction is known as white coat hypertension. We received this account from a reader who had an extreme case:

Q. When I was 18 years old, I went to join the Army Reserves. I weighed 165 and was in great physical condition, but when they took my blood pressure, it was 200/70.

I was told to go straight to my doctor. The blood pressure pill he prescribed made me feel like a zombie.

I bought a home blood pressure monitor; my pressure was 130/70 when I took it. I recently purchased a digital blood pressure unit and log my pressure regularly.

To this day, 35 years later, I still have white coat hypertension. Last week my blood pressure was 200/90 in the doctor’s office and 125/80 at home.

A. Yours is indeed a classic case of white coat hypertension. Most experts believe that home blood pressure readings (especially continuous 24-hour monitoring) are better at determining the actual risk from elevated blood pressure (Current Opinion in Cardiology, online March 16, 2017).

The Italian Experiment:

Many years ago doctors in Milan, Italy, decided to measure the effect the doctor can have on patients’ blood pressure. What they found was incredible!

Within two minutes of walking into a room, the doctor caused an elevation of approximately 27 points in systolic pressure and 15 points in diastolic pressure. Heart rate also jumped up by about 16 beats per minute (Lancet, Sept. 24, 1983).

What we found fascinating about this research is that it included people with hypertension as well as so-called normal (normotensive) subjects. It would appear that when you are feeling vulnerable in a little hospital gown with your tush hanging out, the presence of a health professional in a white coat can make your body react in a flight or fight mode by raising blood pressure and heart rate.

Japanese researchers did an equally interesting experiment. They provided 104 hypertensive patients ambulatory blood pressure monitors. The devices automatically monitored heart rate and blood pressure every five minutes. People were equipped with the monitors before entering the doctor’s office and throughout the time of the visit.

Average systolic blood pressure went up 17 points and diastolic rose 7 points while in the doctor’s room. Heart rate also went up. It took 40 minutes for the numbers to normalize after the patients left the doctor’s office (Clinical and Experimental Hypertension. Part A, Theory and Practice, 1990).

Stories from Readers:

Lindaloo in Albuquerque shared the results of a fascinating “experiment”

“My BP is always high when I go to the doctor. My old MD realized this and diagnosed white coat hypertension. He had me monitor and write down my BP for a month & report back. My blood pressure was normal during the month.

“Several years later I had to change doctors. The new physician was adamant that I had high blood pressure. She sent me to a cardiologist who put a 24-hour blood pressure monitor on me.

“Coincidentally, the next day I had a dermatologist appointment. When the cardiologist read my BP, I told him that I had been to the dermatologist with the monitor on. He said, ‘what time was the appt?’ I replied ‘2 pm,’ and he laughed and said that I had a confirmed case of white coat hypertension. My BP spiked at 1:45 pm and went down by 4 pm!”

Barb in Albany, New York is fairly typical:

“Two days before my routine doctor’s appointment, I took my BP. It was 117/78. In the doctor’s office, after walking down a long hallway and getting on the scale, my BP was taken again. It was 150/90. Got home and several hours later, I took my BP again. It was 120/78.”

GLO reports:

“It’s never a calm experience getting my BP checked at any medical facility. I get called back, they attach the cuff, not necessarily correctly, & attach the oxygen monitor on my finger.

“Sometimes I’m answering questions on whether meds are the same & why I’m there to see the doctor. I have several doctors with both methods of bp testing. One doctor takes readings sitting & standing.

“Regardless of which facility I go to, it’s a sloppy procedure of getting bp readings. I’m taking 2 bp meds. Recently I began feeling really bad & couldn’t get out of bed. The Dr. changed the dosage of both & from time release to pill. I feel better, but am wondering if my bp is high enough to take medication.”

Other Problems with Blood Pressure Readings:

The cuff that is wrapped around your arm could easily be the wrong size. One study found that primary care physicians frequently use a cuff that is too small rather than too large (Lancet, July 2, 1994). This is important because an undersized cuff can overestimate blood pressure by as much as 10 to 30 points.

We have noticed a trend in recent years when it comes to blood pressure measurement. In many clinics doctors and registered nurses no longer perform these measurements. Nurses aids or other lower-cost helpers frequently take blood pressure readings. They may be unaware of proper technique, such as arm placement and posture. The result is that BP readings may be misleading.

What You Can Do:

We discuss white coat hypertension, proper blood pressure measurement and ways to get hypertension under control with and without drugs in our Guide to Blood Pressure Treatment. Anyone who would like a copy, please send $3 in check or money order with a long (no. 10) stamped (70 cents), self-addressed envelope:

  • Graedons’ People’s Pharmacy, No. B-67
  • P. O. Box 52027
  • Durham, NC 27717-2027.

It can also be downloaded for $2 from the website: www.peoplespharmacy.com.

Share your own blood pressure story in the comment section below.

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  1. Inocencia
    Reply

    Magnificent site. A lot of useful information here. I am sending it to a few friends ans also sharing in delicious. And of course, thanks for your sweat!

    https://ro.wikipedia.org/wiki/Wonderful

  2. TB
    Texas
    Reply

    I too suffer from WCH. The only person who doesn’t effect me is my chiropractor that I have been going to for years! When I take my BP at home it’s always low. Even though I’m overweight! The minute I head out the door for my appointment, I can feel my BP rising! I’ve been overweight for years and the first thing they want to do is subject you to the scale, and whether they’re judging/pitying you or not, it still feels like it. When you’re trying to loose weight, that thing is “The Enemy” bar none! So of course my BP goes climbing some more; then they start asking questions, and then, and only then, after they’ve got you good and riled, do they take your BP. What a Shock – your BP is high!
    Here’s what I don’t get: If you get a high reading at the dr’s office, why don’t they *FIRST* ask you to monitor yourself at home and throughout the day for a while BEFORE they automatically prescribe pills? Also, just because they give you a prescription, doesn’t mean you HAVE to Fill it. Especially if you’re educated enough to listen to The People’s Pharmacy and know you’d better do your research before you take ANY medication!
    I know, not everybody listens to TPP, but they Should! (BTW, I’ve lost nearly 40lbs since the last time I was subjected to the dr’s office!)

    • TB
      Texas
      Reply

      That’s supposed to be: TPP – auto spellcheck blunder!

  3. Busy Fingers
    Reply

    My BP is normal even in the Dr office but she says I cant get off the meds. I have A FIB and take Magnesium ever day for this which seems to keep it under control. I take a BP pill and blood thinner everyday as well as Salmon oil and Q10 Vit c in high doses. I shouldn’t mind taking the BP pill but wonder if it is necessary. I have allergies and always suspect drugs as the culprit.

  4. Kathy e
    15024
    Reply

    The medical profession want you to depend on drugs as much as possible it’s how they stay in business, bp intimidation is a biggie and the drugs are often worse than the symptom ” you gave it to me “.

  5. Marilyn
    Florida
    Reply

    I too did experience a “white coat syndrome” with my BP readings whenever I went to the Dr. or the Dentist. After moving to another state and finding a new primary Dr. She took my BP and said it was high and wanted to prescribe a bp pill. I did refuse and told her I would prefer to make a log of my BP readings for a month and report back to her. I did inform her my BP was in the normal range that morning, and it is always higher when I go to the Dr. Needless to say, I did not see her anymore, and found another I was more comfortable with..and understood the white coat syndrome theory. It has been 4 years now, and my BP is still within normal limits w/o meds.

  6. Mary
    Reply

    It may not be all white coats that do it. They tend to not take a resting with no chat plus may not position the arm correctly.
    Google how to do it correctly so YOU will know yourself.

  7. MFK
    Reply

    I deal with white coat hypertension too. It also happens when I get an eye exam: they strap on a wrist monitor, put my hand to my chest, and proceed to ask me questions while measuring the BP! Fortunately, I check my own BP at home so I am comfortable not taking Rx for a non-existent problem. If I didn’t understand how inaccurate this measurement is when I am in a medical setting, and when they do not administer it properly, I would surely be dealing with side-effects from meds. Instead, I work on having a healthy lifestyle and I feel great at 73!

    • TB
      Reply

      That’s supposed to be: TPP – auto spellcheck blunder!

  8. Philip
    TX
    Reply

    My cardiologist’s office is across Houston from where I live. It’s an hour (on a good day) of heavy freeway traffic. Her office is in the Medical Center and last time I had to park on the seventh floor of the parking garage. For once, there was no wait and when they took my BP the systolic was 150+. The doctor immediately wanted to put me on BP meds and I told her that my normal BP is 120/70 with a resting heart rate of 62. The doctor reluctantly assented to my recording my BP daily for 3 weeks and faxing the results. The highest reading of 30 was 129/72. I faxed that to my doctor and received no reply.
    I believe the high reading at the office was a combination of white coat syndrome and stress from the drive. I also believe I would be on a daily BP med had I not protested.

  9. Cara
    Coupeville, WA
    Reply

    I have terrible white coat syndrome. In fact, I suffer from PTSD caused by various mistreatment and abuse by doctors. I actually became paralyzed once while trying to walk into my doctor’s office. I suffer from horrible terror when I go. I feel like I’m facing a firing squad. I no longer want to go to any doctor. I don’t trust anyone in the medical field. And, you’re right. The people taking the bp do not know how to do it correctly, but you can’t tell them anything. They do not listen.

  10. John massey
    staffs.uk
    Reply

    Nurse said my bp was 160/70 .the doctor prescribed ace drugs.I didn’t want to take them so I studied information on how to lower bp.the main thing seemed diet and excersise. Did both and now no drugs and my bp is around 120/75.I am a male aged 74

  11. Robert
    Kernersville, NC
    Reply

    One aspect of white coat hypertension I never see mentioned is anger. Although I’ve been taking my blood pressure at home for over 18 years and getting good readings, my primary care doctor and cardiologist continue to take it. This makes me so angry that the pressure goes up throughout the office visit. It’s almost as if they are taking some sadistic pleasure in doing this. I even told one that some day I was going to have a stroke in his office. All they have to do is stop taking it. I have had it taken at home by a medical professional and it was 100/66. I qualified for long term care insurance at age 67. 70% of people that age don’t qualify. What these doctors are doing is type two malpractice.

  12. Ann
    Alabama
    Reply

    What passes for the medical profession today is a far cry form years gone by.. My experiences with them has been a disaster and I avoid them at all costs.. Finally I found a gem of a doctor who not only listens but is a quiet man as well, instead of a know it all… If you find someone who doesn’t terrorize you… keep him/her…

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