Dangers of White Coat Hypertension

A doctor checking a patient’s blood pressure.
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It is not uncommon to have a perfectly normal blood pressure reading at home only to find that the reading has suddenly spiked once you are at the doctor's office.

Your first instinct may be to throw out the home kit and start hypertensive therapy, but what you may be experiencing is a condition known as white coat hypertension.

Redefining White Coat Hypertension

White coat hypertension (WCH) was traditionally considered a transient and largely harmless event brought on by the stress of visiting the doctor. Research now suggests that this may not be the case.

WCH is triggered by the release of stress-related hormones such as adrenaline, cortisol, epinephrine, and norepinephrine. These are the very hormones that work on the sympathetic nervous system and instigate the so-called "fight or flight" response. Elevated blood pressure is just one of the side effects.

While it may seem reasonable to suggest that being in a doctor's office warrants stress, what researchers have found is that persons with WCH tend to have the same response in other situations which are not inherently stressful. These may include business meetings, social engagements, being stuck in traffic, or even watching the nightly news.

What the research showed was that recurrent spikes in blood pressure had almost as bad an effect on cardiovascular health as persistently high blood pressure, increasing the risk of heart attack, stroke, and congestive heart failure.

Possible Explanations

Another group of research scientists found that people with WCH will often experience increases in blood pressure while sleeping. Typically, the pressure would be expected to dip at night, but, for some reason, this doesn't happen as much in those with WCH.

It has been suggested that the endocrine system of these individuals may be highly sensitized and more likely to secrete stress hormones with even minimal instigation as if "startled."

The abnormal spikes may also suggest an untreated anxiety disorder which is known to increase the risk of a heart attack. As opposed to generalized anxiety disorder (GAD) which manifests with persistent anxiety, there are numerous forms in which the anxiety is triggered by specific events or situations.

Social anxiety disorder (SAD) is one such example where a person may be fine at home but overcome with anxiety when out of the home.

Managing White Coat Hypertension

If you have been diagnosed with WCH, your doctor may recommend ambulatory blood pressure monitoring (ABPM) to track and record your blood pressure around the clock. This can help your doctor assess how frequently and problematic these variations are.

If ABPM is not recommended, you may still be able to get an accurate reading at the doctor's office if you arrive early and sit quietly for at least 10 minutes. If the readings are borderline or inconclusive, your doctor may suggest a watch-and-wait approach.

However, if the elevations are concerning, your doctor may recommend chronic hypertensive therapy. Changes in diet, exercise, and stress management (including yoga and meditation) may also be advised. If anxiety is contributing to the ill effects, you may be referred to a psychotherapist as well.

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Article Sources

  • Huang, Y.; Huang, W.; Mai, Y. et al. "White-coat hypertension is a risk factor for cardiovascular diseases and total mortality." J Hypertens. 2017; 35(4): 677-88. DOI: 10.1097/HJH.0000000000001226.
  • Maseko, J.; Woodiwiss, A.; Libhaber, C. et al. "Relations between white coat effects and left ventricular mass index or arterial stiffness: the role of nocturnal blood pressure dipping." Am J Hypertens. 2013; 26(11):1287-94. DOI: 10.1093/ajh/hpt108.