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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.
Do You Really Have High Blood Pressure?
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. Some years ago, I saw a new doctor because I had found a lump in my breast. My mother died of a rare type breast cancer, so I was anxious.

My blood pressure was so high in the exam room that she called an ambulance and sent me to the hospital. If a doctor or nurse came to check my pressure it went up, but when they walked away it dropped. They had me wear a monitor at home and I was diagnosed with real white coat syndrome.

Waiting to get the results on a breast cancer test makes me very anxious and my blood pressure soars. I am not sure I even need blood pressure medicine. I measure it at home and take my readings with me. Do I really need a drug if my pressure is only high in the doctor’s office?

A. Doctors disagree about the need to treat white coat hypertension. Some think it signals reactivity to stress. Because people are frazzled in many different circumstances, these physicians believe drug treatment is appropriate.

An Italian study of nearly 1200 elderly people with high blood pressure found that white coat hypertension raised the risk for a cardiovascular event slightly but not significantly (American Journal of Hypertension, Nov. 1, 2017). 

Another reader wonders if her blood pressure could be “white coat syndrome:”

Q. I might have to go on a blood pressure-lowering medication, but I am very reluctant to do so. Instead, 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.

Keeping a diary of your home readings may help. You will find more information on white coat hypertension and non-drug approaches in our eGuide to Blood Pressure Solutions. It can be found in the Health eGuides section of this website. 

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). 

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
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
Citations
  • Pierdomenico SD et al, "Prognosis of masked and white coat uncontrolled hypertension detected by ambulatory blood pressure monitoring in elderly treated hypertensive patients." American Journal of Hypertension, Nov. 1, 2017. DOI: 10.1093/ajh/hpx104
  • 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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