White Coat Hypertension – Should I Worry?

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Have you heard of the term white coat hypertension?

Many times, patients walk into a clinic or a doctor’s practice in order to get a complete health checkup done. At the time the blood pressure is checked, it is found to be high.

However, when they get their blood pressure checked at home (on a machine or by a family member), it is normal.

This phenomenon where a person’s blood pressure is high in a clinic but normal at home is called white coat hypertension. It is also called white coat syndrome.

The Problem With White Coat Hypertension

The primary issue that is associated with diagnosing patients with white coat hypertension is that a large proportion of them may be commenced on the treatment they don’t actually need.

It is therefore essential to know if a patient really has got a high blood pressure or whether they just have white coat hypertension.

The school of thought regarding white coat hypertension has recently changed. What was previously thought to be a ‘humorous’ twist on blood pressure going up at the sight of a doctor is now considered to be a problem that may have long-term effects on the heart and other vital organs.

Clinical studies have found that white coat hypertension may be associated with an increased risk of heart attacks. This is in comparison individuals who have sustained high blood pressure.

There are also individuals who suffer from a condition called masked hypertension. This is where the blood pressure is normal in the clinic setting but high at home. This is a problem as well and I will address this in a separate article at some point.

The White Coat ‘Effect’

There is also another phenomenon called white coat effect, which is a condition where the blood pressure of an individual who is already on treatment for high blood pressure is high in the clinic but normal at home.

This also creates a problem in treating these patients and further investigations are usually required to confirm its presence or absence.

Diagnosing White Coat Hypertension

The prevalence of white coat hypertension is significantly high in our country and across the globe.

It can be a fairly difficult task diagnosing white coat hypertension without having the patient monitor their blood pressure regularly at home.

I was recently a part of the India Heart Study, which is a clinical trial that looked at the prevalence of hypertension in normally healthy populations.

These individuals had no diagnosis of hypertension in the past and were not taking any medication whatsoever.

It appeared that the overall prevalence of white hypertension in India is around 24%, which matches what we currently see in the rest of the world.

In other words, nearly 1 in 4 patients notice their blood pressure shooting up when they see a doctor.

This makes diagnosing white coat hypertension correctly an extremely important issue.

One of the best ways to diagnose whether a patient has truly got high blood pressure is to conduct a test called ambulatory blood pressure monitoring.

I have discussed this elsewhere on the blog, but to summarise, this test is where the pressure is recorded very frequently throughout the day with a device that is attached to the patient’s arm.

The device records the blood pressure even during the sleep when the patients are in their most relaxed state.

Take a look at the graph below. As you can see, the blood pressure of the patient was high in the clinic (above the green line) but as soon as they went home their blood pressure was normal. This is a classic case of white coat hypertension.

Management Of White Coat Hypertension

In an attempt to lower the blood pressure of patients with white coat hypertension, doctors have pretty much stopped wearing their white coats!

However, it is not the white coat that is the problem. It appears to be the actual environment of a doctor’s consultation room.

Over the last decade or so, I have encountered numerous patients whose blood pressure is high in the clinic. These patients have gone on to tell me that when they have checked their pressure at home, it has been normal.

In order to confirm if they have got true hypertension or not, I usually ask the patient to lie down in the room next door to my consultation room and get the blood pressure checked after 10 minutes of rest and relaxation.

This BP is usually checked by a staff member of mine. Many times the subsequent readings have been lower than what they were in my clinic.

Clearly, being a little more relaxed has a positive effect on preventing blood pressure spikes in the clinic.

Yoga

As a general rule, regular yoga can reduce your heart rate and blood pressure and can make you mentally a lot stronger and more relaxed. As a form of stress relief, yoga is an excellent technique to prevent white coat hypertension.

Cardiovascular Exercise

Performing regular cardiovascular exercise such as brisk walking, running, swimming and cycling can help lower blood pressure and maintain values even during times of stress.

Stop Smoking

Smoking has been strongly linked to the development of high blood pressure and heart disease. Stopping smoking can help bring down blood pressure spikes and may prevent white coat syndrome.

Reduce Salt Intake

Lowering your intake of sodium can help lower blood pressure. Avoid junk foods and fried foods as these contain a lot of salt in them. Also, look for hidden salts in over-the-counter foods.

Conclusion

White coat hypertension is a well-recognized problem that may lead to heart disease in the future. Make sure you take the right steps and keep your blood pressure low!

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Dr Vivek Baliga B

Consultant Internal Medicine And Cardiovascular Sciences at Baliga Diagnostics Pvt Ltd
Dr Baliga is a consultant in Internal Medicine and Cardiology with an interest in diabetes and cardiovascular disease. He received his training in India and the UK where he completed his post graduate training and his doctorate. He then completed his MBA from University of Phoenix, USA. He has completed the post graduate program in Cardiology from Johns Hopkins University and participated in the Advanced Certificate Course in Diabetes from the Cleveland Clinic, USA. He also holds a Post Graduate Diploma in Lipid Management from Middlesex University, UK. He is the managing partner of Baliga Diagnostics, Bangalore. He is also the founder of HeartSense and is a keen advocate of patient empowerment, having written almost every article on this website and more. In his spare time, he enjoys running and spending time with his son. Find Dr Vivek Baliga on LinkedIn here - http://heartsense.in/linkedin.
Dr Vivek Baliga B
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6 Comments

  1. C.Saranga Pani. on

    Sai Ram, Thanks for your informative mails on various matters connected with our health. Kindly let me know whether I can have a medical checkup done at your clinic (I will be 90 next month end) and if so what are the details including charges for the same. My experience with some earlier checkups in other places was not very helpful , it only gave a not of reports about various tests done.

    Please let me have a response early and oblige

    c.s.pani

    • White Coat Hypertension – an interesting writeup worth sharing. The doctor wearing the white coat in one sense comforts the patiencents that they are in safe hands not to worry but according to the above writeup it will also puts one under tension. According to sociological studies we know that the light, colour, space and surroundings plays an important role in well being of the patients. I hope more and more research will be done in these less known areas along with the application of technology in the modern medicines.

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