White Coat Hypertension: What Is It And Do You Have It?

Health & Wellness

White coat hypertension, or the white coat effect, is when your blood pressure is normal at home but elevated at the doctor’s office. Named after the color of the gowns that medical professionals wear, white coat hypertension may seem like a fleeting, benign condition.

After all, it seems normal to be nervous at the doctor’s office. But white coat hypertension, which affects an estimated 15-30 percent of all Americans, could indicate a far more serious problem.

A study in the Journal of the American College of Cardiology revealed that white coat hypertension is associated with increased aortic stiffness, renal injury, stroke, heart attack and heart failure. 

The study also reached the same conclusion for those people who have ‘masked hypertension,’ which is when blood pressure readings are normal in a medical setting but higher elsewhere. 

Another study in Hypertension reached similar conclusions, finding that white coat hypertension is strongly associated with heart disease. 

What Causes White Coat Hypertension? 

Visiting the doctor’s office can trigger anxiety in some people. For some, there’s a fear of being given a bad diagnosis. 

But other factors may contribute to the condition, such as poor diet, lack of exercise, and new stressful triggers such as losing a job. 

In another study on white coat hypertension, published in the New England Journal of Medicine, researchers conducted a 10-year study involving nearly 64,000 people. The researchers determined that patients with white coat hypertension have twice the risk of death as those with normal pressure both at home and at the doctors.   

If you have white coat hypertension, the good news from the study is that blood pressure measurements taken at home regularly are a stronger predictor of cardiovascular deaths than blood pressure reading taken in a medical setting. 

How To Take Your Blood Pressure

The American Heart Association recommends using a cuff style, automatic, upper arm monitor. The finger and wrist monitors are not recommended because the results are far less reliable. While the monitor is being used, the person should remain still. Thirty minutes prior to and after measuring the pressure, the individual should avoid smoking, exercise and caffeinated beverages. The bladder should be empty and a minimum of five minutes of quiet rest should be used prior to taking the pressure.

The individual should sit properly. The back should be supported by a straight-backed chair and upright posture should be maintained throughout the reading. The legs should remain uncrossed and the feet resting on the floor. A flat surface should be used to support the arm. The upper arm should be raised enough to be level with the heart. The middle of the cuff should rest right above where the elbow bends. 

The test should be done at the same time each day, multiple readings should be taken and the results recorded. 

What Is Considered High Blood Pressure?

According to the American College of Cardiology and American Heart Association guidelines, blood pressure is considered high if the reading is 120/80 or higher. Stage 1 hypertension is 130/80 to 139/89. Stage 2 hypertension is 140/90 or higher. If the reading reaches or exceeds 180/120 the individual is deemed to be in a hypertensive crisis. This requires either hospitalization or immediate treatment. 

Stressors are a part of life. The important thing to remember is the impact of these stressors must be controlled to prevent damaging the blood vessels. The best way to accomplish this is by controlling the pressure.

How Often Should Blood Pressure Be Taken?

Regularly. So-called “ambulatory blood pressure monitoring,” which measures blood pressure at regular intervals, is a more accurate predictor of hypertension than occasional readings at home or at the doctor’s office. In addition, ambulatory readings can negate the effect of white coat hypertension.  

And thanks to modern technology such as smart watches and portable 6-lead ECG (electrocardiogram) devices, it’s never been easier to regularly monitor your blood pressure.

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