Understand White Coat Syndrome: Definition, Causes, Diagnosis, and Cure

Key Takeaways

1. WCH occurs in 15-30% of people, causing elevated blood pressure during doctor visits.

2. If BP is higher at the doctor's office than at home, it may be WCH, leading to potential misdiagnosis.

3. Understanding WCH involves recognizing its symptoms, causes, and the importance of accurate readings.

4. Management and prevention include relaxation techniques, lifestyle changes, and open communication with your doctor.

White coat hypertension causes readings in the high BP range at the doctor's office about 15-30% of the time. If your blood pressure is higher at the doctor's office than at home, you may have white coat hypertension. This can lead to misdiagnosis of hypertension.

Hence, let's understand white coat syndrome, its symptoms, causes and diagnosis. We will also provide you with some tips to beat white coat hypertension.

What is White Coat Syndrome (Hypertension)?

White coat hypertension (WCH), also called white coat syndrome, is the phenomenon of getting high blood pressure readings when the doctor is checking your BP. But your blood pressure at home or in other settings is normal. The name white coat is because the doctors who measure blood pressure often wear a white coat.

Normal blood pressure falls below 120/80 mm Hg, while readings surpassing 130/90 mm Hg indicate hypertension. In the case of white coat hypertension, your home monitor may show readings below 120/80 mm Hg. However, readings at the doctor's office could surpass 130/90 mm Hg.

White coat hypertension might not seem a major issue. However, every year, doctors diagnose hypertension in about 5% of people who actually have white coat hypertension. This might lead them to prescribe medicines that you do not need, leading to side effects like hypotension (abnormally low BP).

WCH may also signal a risk of developing hypertension in future and increased cardiovascular and organ damage risks.

Risks of White Coat Hypertension

While WCH itself may not cause immediate health problems, recent research suggests it might increase your long-term risk of developing:

• High blood pressure (hypertension)
• Cardiovascular issues like heart disease and stroke

Even with normal home blood pressure readings, WCH can be a sign of underlying problems with blood pressure regulation.

White Coat Hypertension Causes

We all are anxious when visiting the doctor's office. But some people are more susceptible to it than others. For example, seeing a doctor may trigger the "flight or fight" response in some individuals, resulting in a surge in blood pressure.

People who have had negative experiences with doctors are more likely to experience WCH. Anxiety about blood pressure checks at the doctor's office increases the likelihood of WCH.

The other things that may affect your blood pressure are:

• Time of the day
• Your activity levels
• Stress
• Smoking, caffeine or alcohol consumption
• Anxiety
• Your emotional state

Symptoms of White Coat Syndrome

White coat hypertension does not present any symptoms. You may feel stress or anxiety that may be increasing your BP. 

White Coat Hypertension: Diagnosis and Tests

When your blood pressure seems high at the doctor's office, they might want to monitor it over the next few weeks or months. But If you've experienced white coat hypertension before, it could happen again. Hence, your doctor might recommend checking your blood pressure at home to make things more transparent.

You can do it with a home BP monitor, which you can purchase online or from a pharmacy store. Using this monitor, you can take multiple readings daily and show them to your doctor for their opinion.

Another option is to get an ambulatory blood pressure monitor. You can strap this device to your body and wear it for a day to 2 days. It measures your BP every 20-30 minutes after wearing it. 

Hence, by checking BP at home and comparing you readings with those you get at the doctor's office, your doctor can diagnose you properly.

Tips to Beat White Coat Hypertension

Avoiding white coat hypertension can give you a more accurate reading and prevent misdiagnosis. You should follow these simple tips to beat white coat hypertension.

1. Don't worry about the results: WCH can create a self-fulfilling prophecy, as worrying about a high blood pressure reading during measurement can result in elevated BP.
2. Give yourself time to relax: If you are anxious, you can ask the doctor to give you a few minutes to calm down and relax.
3. Practice breathing exercises: Breathing exercises are excellent to relax your body and deal with anxiety. So, learn some breathing exercises and practice them before entering the doctor's office.
4. Change the topic: Discussing blood pressure can be stressful. You can either try to discuss something else with your family member or don't talk.
5. No smoking or caffeine consumption: Smoking and caffeine can temporarily increase your blood pressure reading. Make sure you don't take these things before going to the doctor.

White Coat Hypertension Cure

Your doctor would only treat hypertension only if you have other lifestyle diseases like diabetes. Primarily, white coat hypertension treatment involves lifestyle changes to improve your heart health. Some changes you can make include:

• Practice relaxation techniques before doctor visits: Techniques like deep breathing and meditation can help manage stress and anxiety in everyday life, not just at doctor's visits.
• Engage in regular physical activity: Consider activities you enjoy: Walking, swimming, biking, dancing – find activities you find fun and can stick with long-term.
• Maintain a healthy and balanced diet: Even with normal blood pressure, a healthy lifestyle is essential for preventing heart disease and other chronic conditions.
• Limit caffeine and sodium intake
• Get adequate and quality sleep
• Manage stress through activities like meditation or deep breathing
• Establish a trusting and open relationship with your doctor to discuss fears or apprehensions: Open communication about your WCH and any anxieties you have can help your doctor provide better support and ensure accurate blood pressure readings.

FAQ's

Is white coat syndrome real?

Yes, white coat syndrome is real and affects about 15 to 30% of people who get their BP checked in the doctor's office.

Is white coat syndrome dangerous?

Yes, white coat hypertension may potentially be dangerous. If you have white coat hypertension, your chances of developing hypertension is higher in the long run. Also, it might lead to a misdiagnosis of hypertension, leading you to start hypertension medication without having the disease. 

Does anxiety disorder cause high blood pressure?

Having anxiety does not cause long-term hypertension. However, it can spike your blood pressure when you are feeling anxious. Hence, having an anxiety disorder may cause WCH if you feel uneasy during a doctor's visit. 

Conclusion

Understanding white coat hypertension is crucial to avoid potential misdiagnosis and unnecessary medication. In 15-30% of cases, this phenomenon manifests as elevated blood pressure during doctor visits but normalizes elsewhere. Mistaking it may lead to unwarranted hypertension treatment and associated side effects.

By following tips and fostering open communication with your doctor, you can manage WCH, ensuring accurate readings and personalized care.

Consider using the Aware Health Tracker app to track your BP and improve your heart health. Along with tracking, Aware also provides daily nudges to improve your health and prevent you from developing hypertension. Download the Aware Health Rewards app today!

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About the author:

Lucky Mehtani, B. Pharm, merges his healthcare expertise with a passion for writing to enhance India's heart health. Through insightful blogs, he provides well-researched information on managing Diabetes, Hypertension, and High Cholesterol, aiming to prevent heart attacks and strokes.