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Do You Really Have High Blood Pressure?

People who have high blood pressure in the doctor's office may need to confirm that it is sustained throughout the day with home blood pressure measurement.
Close-up partial view of nurse measuring blood pressure to senior patient

Have you been told you have high blood pressure? Doctors recognize that untreated hypertension can increase your chance of developing heart disease, kidney damage or stroke. Consequently, you should take steps to keep your blood pressure under control. First, however, you should find out what it actually is so you will know if it is truly elevated.

Is It White Coat Hypertension?

Q. I might have to go on a blood pressure-lowering medication, but I am very reluctant to do so. I exercise regularly at the gym, lifting weights and doing cardio five days a week for an hour. I also walk in the evenings when weather permits. My diet is very healthy and at 5’7” I weigh between 115 and 117 lbs.

Yet when I see a doctor my blood pressure jumps to 150/90. Could it just be “white coat syndrome?” The doctors seem reluctant even to consider this. They want to hand me medications right away, regardless of any side effects. If the subject comes up on my next visit, I’d like to know which medicines would have the least objectionable side effects.

What Is White Coat Hypertension?

A. It is certainly possible that you have white coat hypertension, a condition in which blood pressure soars in the doctor’s office but is normal at other times. Presumably this is due to anxiety around the interaction. Stress can contribute to high readings.

To learn whether your blood pressure spikes only at those times, or whether it is more generally elevated, you will need to measure it yourself at home. Consumer Reports rates the Omron 10 series of home blood pressure monitors highly.

Measure Your Blood Pressure Properly:

Blood pressure must be measured correctly both in the doctor’s office as well as at home. It is harder than you might think. Keep your feet on the floor and your back supported. Your arm should rest on a horizontal surface at heart height. Do not talk during the measurement. Sometimes the nurse or medical assistant will chat with you to put you at ease, but talking can mess up the results.

Other people have had to deal with a similar problem.

Handling White Coat Hypertension:

Q. My blood pressure at home is normal without medication (110/68). I take it with a BP machine checked by a cardiologist.

In a medical setting, it’s sky high and doctors get upset. I have been prescribed medication for blood pressure, but it doesn’t keep my pressure down at the doctor’s office. No heart or artery disease has been found.

I am 65 and this has been happening since I was in my early 30s. At the doctor’s office I feel panic. Any suggestions?

A. You describe “white coat hypertension” perfectly. Many people react as you do with panic and soaring blood pressure in a medical setting. Stress leading to panic can really boost the pressure in your arteries.

iMedical Consensus Advisory

Blood pressure control is essential to reduce your risk of kidney, heart and brain problems. It takes more than one high reading to diagnose hypertension, and those measurements must be conducted correctly. So-called white coat hypertension, with readings elevated in the clinic but not at home, is common. Doctors don't agree on how aggressively such patients should be medicated.

Keeping a diary of your home readings may help. You will find more information on white coat hypertension and non-drug approaches in our Guide to Blood Pressure Treatment.

When Home and Office Blood Pressure Readings Clash:

Doctors have long debated how vigorously white coat hypertension should be treated. Some recognize that during much of a normal day, the patient’s blood pressure is quite normal, and don’t worry too much about the elevation that shows up in medical settings (Current Cardiology Reports, March 8, 2018).

Others argue that vascular pressure rising under stress puts the patient at risk. They prefer to treat with enough medication to keep blood pressure from becoming too high even in the doctor’s office. A meta-analysis of 23 long-term studies found that if this condition goes untreated, it can raise the risk of heart disease and premature death (Journal of Hypertension, April 2017). 

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A study that followed 6,458 people for more than eight years found that untreated white coat hypertension carries some risk, but blood pressure that is high both at home and in the office is the most dangerous (Stergiou et al, Hypertension, April 2014).

Masked hypertension, in which blood pressure runs higher at home than at the doctor’s office, presents more of a risk of cardiovascular complications than white coat hypertension does  (American Journal of Hypertension, online Nov. 14, 2014). Women are more likely to experience white coat hypertension, while men appear more susceptible to masked hypertension (Sheppard et al, American Journal of Hypertension, May, 2016).

Getting Your Pressure Under Control:

You will find some helpful hints in our review on treating hypertension. Besides antihypertensive medications, you can learn to slow your breathing, meditate, exercise regularly and follow a DASH diet. Any of these approaches can help you reduce your blood pressure and your risk of a heart attack.

To learn more about proper measurement technique, white coat hypertension and strategies for controlling hypertension, you may wish to consult our Guide to Blood Pressure Treatment

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
Blood Pressure Treatment

Learn about pros and cons of the various medicines used to lower blood pressure, as well as multiple non-drug approaches to blood pressure control such as diet, supplements and special foods.

Blood Pressure Treatment
  • Abolbashari M, "White coat hypertension and cardiovascular diseases: Innocent or guilty." Current Cardiology Reports, March 8, 2018. DOI: 10.1007/s11886-018-0964-0
  • Huang Y et al, "White-coat hypertension is a risk factor for cardiovascular diseases and total mortality." Journal of Hypertension, April 2017. DOI: 10.1097/HJH.0000000000001226
  • Stergiou GS et al, "Prognosis of white-coat and masked hypertension: International Database of HOme blood pressure in relation to Cardiovascular Outcome." Hypertension, April 2014. DOI: 10.1161/HYPERTENSIONAHA.113.02741
  • Niiranen TJ et al, "Optimal number of days for home blood pressure measurement." American Journal of Hypertension, May 2015. DOI: 10.1093/ajh/hpu216
  • Sheppard JP et al, "Predictors of the home-clinic blood pressure difference: A systematic review and meta-analysis." American Journal of Hypertension, May, 2016. DOI: 10.1093/ajh/hpv157
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Years ago, my GP insisted I had high blood pressure even though I told her it is not high at any other doctor’s office or at home. She always checks blood pressure with a cuff and stethoscope. Finally she had me wear a blood pressure monitoring device for two days. The results showed no high blood pressure. She claims I have white coat syndrome. Her nurse confided in me that she thinks the doctor has some hearing loss. In recent years the office started using automatic readers. No more high blood pressure at my office visit.

When my doctor put me on meds for my blood pressure I decided to get a cuff for home and start taking it daily. I looked up online how to correctly take my blood pressure and soon realized that the nurse at the doctor’s office was not following the guidelines for taking an accurate blood pressure. My plan is to talk to my GP on my next visit to ask if I really have high blood pressure because it is always normal or low at home.

My previous dr had diagnosed me with high blood pressure & put me on Lisinopril. After going to the dentist a few times (where they do blood pressure), my blood pressure was down to 100/52. I called my new dr, and he told me to stop taking meds and see him in 10 days. My pressure was completely normal. At the previous office, I had to walk across 2 large rooms, go up a flight of stairs, down a long hallway, sit down with my feet dangling & nowhere to support my arm while they immediately took my blood pressure. So glad to be off meds & have a dr who knew how to take blood pressure readings correctly!!

Twice in the last 3 months I’ve had my BP taken where the person taking it put the cuff around my arm and then just let my arm hang there in the air. The first time I held my arm straight out and the second time I left it hang at my side. Both times I had a very high reading but nothing was said about it. One was in a surgeons office and the other in outpatient radiology for a CT scan. I don’t think the young technicians understand the important of how to administer a BP test.

I have high blood pressure and find that it varies even in the doctor’s office. I have discussed white coat high blood pressure. I spoke with my doctor about it. He really did not have a clue about the cause although my blood pressure was lower when he took it compared to his nurse ten minutes earlier.

I have a nurse friend who believes in conventional medicine and is very much of a rigid fundamentalist on blood pressure medications. I have found that at times my blood pressure goes up an hour after I take the meds compared to the days I skip them. But I do have high blood pressure days w/o the meds so I am taking them although not regularly irregularly I am focusing on diet and meditation and self-experimenting whether this with acupuncture is a reasonable alternative. Forgot to mention: I am a doctor

Doctor’s offices never take BP measurements as per recommendations. So any number can result. During recent visits to doctor’s offices both my wife’s and my measurements varied 10 to 25 points (systolic) over several visits. So I’m not sure what our real BP is.

Even when taking my own BP at home I see huge variations that can’t be explained. It always follows a pattern: first reading is high, second is low and as much as 10 or 15 points, third is a few points higher than the 3rd. I’ve repeated this over years and it never changes so what is my real BP???????

Dear Terry and Joe,
Thank you so much for your ongoing wonderful and thoughtful radio show. I have learned a great deal by listening and have been inspired.

Your “heart”, goodness and sincerity, shines through, also.

I’ve notice that blood pressures are not correctly performed in the doctor’s office. The CMAs are in a hurry from a busy schedule, don’t make sure the arm is above the heart level, and perform the manual BPs over sweatshirts or any heavy clothing. At home you can relax, take your time, keep your arm elevated, and slip your arm out of your shirt. My doctor recommended adding another BP med until I sent him a week of home readings. He said “Never mind!”

A few weeks ago an MD from BC BS came to my home for an evaluation. When she took my BP she asked me to stand, keep my eyes open. She was also trying to converse with me at the same time. She then proceeded to tell me I had hypertension. I told her I take my own BP frequently, was taken a week ago at the MD office and usually within normal range.

Great articles. Was told I needed to go on high blood pressure meds. Got a monitor from Costco and it told a different story. So never did and am doing just fine. Really enjoy all the articles on The People’s Pharmacy. See denial all around me and people not using common sense. Its not all doom and gloom but get informed. I already have lasting effects from taking Cipro with snaping and cracking sounds. And one of the best places to get informed is this site. Thanks for all you do, Mike.

High blood pressure? Its the automatic blood pressure cuffs. I “tighten up” when they are used. They hurt and it doesn’t help to breathe in and out, trying to relax. The last time the blood pressure was taken, the assistant took it twice because it was so high. Both times the procedure hurt like. It’s very difficult to relax when the pain is so intense.

I don’t believe I have had my blood pressure measured properly in many years. I recently refused to even have it tested when the health care professional tried to test it while my feet were dangling from the exam table. I had just walked into the exam room. My arm was not supported. My last memory of it being taken properly was when I was in my 20s; I am now 75.

Patients should not be sitting on an exam table, legs and arms dangling, when having blood pressure taken.

I demand that my pressure be taken while I am sitting in a chair with arm supported at a comfortable level and take a couple of deep breaths before allowing my blood pressure measurements. This brings my pressure to normal every time.

Medical staff don’t like this because it adds another minute to their time with me, but I remind them it’s my health.

There are a few studies that suggest that BP along with diets and medications may need to be personalised. Nothing in the human body is so clear cut:

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