Is your doctor really causing your high blood pressure?
At home, your blood pressure is normal, and you have no symptoms of high blood pressure. Then, you visit your physician, and to your surprise your blood pressure is high! You may have white coat hypertension, also known as white coat syndrome…
What is white coat hypertension/syndrome?
White coat hypertension, more commonly known as white coat syndrome, is a form of labile hypertension: people exhibit a blood pressure level above the normal range in a clinical setting, even though they do not exhibit it in other settings. The phenomenon is generally associated to the anxiety many patients experience during visits to the doctor.
There are two important aspects here, however:
- Statistical data demonstrates that the percentage of people showing white coat hypertension is usually bellow 30%, and it can be as low as 10%. Caution must therefore be exercised before concluding that: “my blood pressure only goes up when I am in front of my doctor”. Your blood pressure may also be high at home.
- If you experience white coat hypertension, you may also have a higher risk of developing certain cardiovascular problems compared with people who always have normal blood pressure. Some doctors think white coat hypertension might signal that you are at risk of developing high blood pressure as a long-term condition.
Conversely, there are people who have normal blood pressure in the doctor’s office, but periodic spikes when measured in other settings. This clinical situation is called masked hypertension.
Both white coat hypertension and masked hypertension can lead to serious issues. If you have, or think you have, white coat hypertension, talk to your doctor about home monitoring of your condition. Your doctor may ask you to wear a blood pressure monitor (ambulatory blood pressure monitor) for up to 24 hours to track your blood pressure during daytime, as well as during your sleep. This can help determine if your high blood pressure only occurs in the doctor’s office or if it is a persistent condition that needs treatment.
Arterial hypertension is a silent killer
High blood pressure silently wears down the human body and increases the likelihood of diseases, such as stroke or myocardial infarction. Even in the absence of visible symptoms, it is important to take regular blood pressure measurements and adopt healthy lifestyle habits. These habits are essential in preventing increases in blood pressure, especially for hypertensive people with high cardiovascular risk. The following recommendations are particularly important:
- Adopt a low sodium (salt), low fat diet;
- Add more fruits and vegetables to your meals;
- Do not smoke;
- Practice physical exercise frequently (moderate walking for 30 minutes, five to seven days a week; or for 75 minutes, three times a week); and
- Avoid excessive consumption of alcoholic beverages.
Findings of a meta-analysis (involving 27 studies) confirmed that patients with white coat hypertension were more than twice as likely to die from a cardiac event as those whose blood pressure readings were always normal. These patients also had a 33% increase in mortality risk and were 36% more likely to experience a cardiac event (e.g., heart attack).
Current evidence suggests that white coat hypertension is associated with cardiovascular risk factors, including the development of sustained hypertension and the presence of target organ damage (heart, kidneys, brain).
Hypertension is a preventable cause of disability and premature mortality worldwide. Check your blood pressure levels regularly and stay healthy.
References:
- Cohen JB et al. “Cardiovascular events and mortality in white coat hypertension: a systematic review and meta-analysis.” Annals of internal Medicine 170; 12 (2019): 853–862.
- Nuredini G et al. “Current status of white coat hypertension: where are we?.” Therapeutic Advances in Cardiovascular Disease 14 (2020)
- Unger T et al. “2020 International Society of Hypertension global hypertension practice guidelines.” Hypertension 75; 6 (2020): 1334–1357.
