White Coat Syndrome
What is white coat syndrome?
White coat syndrome is a condition in which your blood pressure is high at your healthcare provider’s office, but you get a normal reading at home. A normal blood pressure reading is less than 120 millimeters of mercury (top number) and less than 80 millimeters of mercury (bottom number).
White coat hypertension is a concern because every year, 5% of people with white coat syndrome get a hypertension diagnosis.
An accurate blood pressure reading tells you whether you need treatment or not. If your reading isn’t correct, you could be getting medicine you don’t need or medicine that’s too high of a dose. If your blood pressure reading is artificially high in the office, your provider may think your medicine isn’t working.
Is white coat syndrome real?
Yes, white coat syndrome is real. Researchers have done multiple studies about it and documented their findings.
Is white coat syndrome dangerous?
It can be. People who have white coat syndrome may have blood pressure that’s a little bit higher than those who don’t have the syndrome. According to studies, high-risk people older than 60 may also have twice the risk of heart issues compared to low-risk people with this syndrome.
High-risk means they already had a heart attack or have diabetes or other risk factors. It may be these risk factors, and not white coat hypertension, that increases their risk.
Who gets white coat syndrome?
People who are more likely to have white coat syndrome include those who:
- Are older than 50.
- Were assigned female at birth.
- Were diagnosed recently with high blood pressure.
- Have obesity.
- Don’t use tobacco products.
How common is white coat hypertension?
White coat hypertension affects 15% to 30% of people who have high blood pressure. People without high blood pressure can have it as well.
Symptoms and Causes
What are the symptoms of white coat syndrome?
If you have white coat hypertension, you may feel nervous when you get to your healthcare provider’s office. This nervous feeling may get worse when you go into the exam room and get a blood pressure measurement.
How does white coat syndrome affect my body?
White coat syndrome is linked to:
- Stiffness in your arteries.
- Worse blood vessel function.
- Higher cardiovascular mortality.
- Higher risk of getting left ventricular hypertrophy.
- Higher risk of having diabetes or high blood pressure.
What causes white coat syndrome?
Your body may have a reflex or response to having your blood pressure checked when you’re concerned about the results. Arriving at your healthcare provider’s office, entering their exam room and actually getting a blood pressure reading can cause this reaction. This is like a “fight or flight” response people have when they sense danger.
It’s normal for blood pressure to be different depending on:
- The time of day.
- Whether you’ve rested before taking it.
- The amount of noise around you.
- How you’re feeling emotionally.
Diagnosis and Tests
How is white coat syndrome diagnosed?
Your healthcare provider can diagnose white coat syndrome when you have at least three in-office readings that are higher than normal but requires either 24-hour ambulatory blood pressure monitoring or home blood pressure monitoring.
These readings in the office would be 140/90 millimeters of mercury or higher, but your 24-hour ambulatory blood pressure measurement (at home) is less than 135/85 millimeters of mercury.
Management and Treatment
Does white coat syndrome go away?
White coat syndrome tends to continue for years. This can happen even if you’re seeing the same healthcare provider every year and are comfortable with them.
How is white coat syndrome treated?
Your healthcare provider may want you to check your blood pressure often to make sure you don’t develop high blood pressure. You can buy an automatic blood pressure monitor to use at home. Also, many pharmacies have machines that take your blood pressure for you.
Your provider may ask you to make some lifestyle changes, such as:
- Exercising more often.
- Losing weight.
- Reducing how much salt you eat.
- Avoiding the use of tobacco products.
If you have other cardiovascular risk factors, such as obesity or tobacco use, your provider may want you to take blood pressure medicine (antihypertensives).
How to overcome white coat syndrome
Helping yourself feel more relaxed may bring your blood pressure closer to what it is at home.
These tips may help:
- Develop a good relationship with your healthcare provider so you can talk with them easily.
- If you don’t feel comfortable with your provider, find a different one.
- Bring a list of questions so you’re not anxious about forgetting to ask them.
- Allow extra time to get to your appointment and park so you don’t feel stressed.
- Don’t smoke, drink coffee or exercise for a half-hour before your appointment.
What medications/treatments are used to treat white coat syndrome?
Healthcare providers usually treat white coat syndrome only if you have other cardiovascular risks. Making lifestyle changes like losing a few pounds or eating less salt may be your treatment. People who are at a high risk for heart issues may need to take blood pressure medicine (antihypertensives).
What are the side effects of the treatment?
Side effects of antihypertensives may include:
- Upset stomach.
How can I reduce my risk of white coat syndrome?
Better communication with your healthcare provider can make you feel less anxious. This can make you less likely to get white coat hypertension.
Outlook / Prognosis
What can I expect if I have white coat syndrome?
Studies show that people with white coat hypertension have a higher risk of cardiovascular issues than people who have normal blood pressure. However, people who take blood pressure medicine and have white coat syndrome don’t have a higher risk of heart problems compared with people who have normal readings.
How do I take care of myself?
Keep checking your blood pressure at home to make sure your blood pressure is staying normal. Contact your healthcare provider if you get several high blood pressure readings.
What questions should I ask my doctor?
- How often should I check my blood pressure at home?
- What’s the appropriate way to take my blood pressure at home?
- Can I bring in my blood pressure monitor so you can check its accuracy?
A note from Cleveland Clinic
It can be upsetting to hear your healthcare provider read high numbers when measuring your blood pressure. But you may just be nervous about being in the doctor’s office. Check your blood pressure at home or at your pharmacy. If you get normal numbers, let your provider know so they can update their records. You should tell them if you get high readings too, because that means you could actually have high blood pressure. The only way to know is to keep checking your blood pressure.
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