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.”
“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.