Does this type of elevated BP need to be treated?
It’s perfectly normal to be a little stressed or jittery at the doctor’s office. Maybe you rushed there after dropping off your kids at school or in between meetings at work, worrying about traffic and whether you’d be late. Maybe you’re nervous about the health problem that brought you to the doc and if it could be something serious. Maybe you’re annoyed you’ve been waiting for 20 minutes and there’s still two people ahead of you.
So it’s no wonder that you may be in a slightly less-than-calm mood as the nurse straps a blood pressure cuff around your arm. If you’ve ever worried this in-office stress could skyrocket your results, you’re probably not surprised that there’s a term for this: white coat hypertension, or high blood pressure only in the doctor’s office, but not in everyday life. This phenomenon is so common that it accounts for 15 to 30 percent of patients with elevated blood pressure during a doctor’s visit, according to a 2013 study in the journal Hypertension.
“White coat hypertension is stage fright,” says Satjit Bhusri, MD, a cardiologist at Lenox Hill Hospital. “You’re going to a doctor’s office. You don’t want to hear bad news. You get anxious [and] have that fight-or-flight response.” This produces well-recognizable symptoms: sweaty palms, rapid heartbeat, dilated eyes, constricted blood vessels, and—yep—an elevated BP. But white coat hypertension is a temporary state and not the same as having high blood pressure.
Recognizing white coat hypertension is crucial because it could result in a faulty diagnosis. “You don’t want to be treating blood pressure based on just one or two numbers when the reality is that a patient’s blood pressure is well controlled,” says Michelle Weisfelner Bloom, MD, a cardiologist at Stony Brook University Medical Center.
The opposite can also occur: “You may notice that your blood pressure in the office is perfectly normal but then your blood pressure at home is very high,” says Rachel Bond, MD, a cardiologist at Lenox Hill Hospital. “That’s something called masked hypertension.”
For patients with either masked hypertension or white coat hypertension, regular BP monitoring is recommended.
“These are patients we’re going to want to closely keep an eye on because they are at a little bit of a higher risk of having elevated blood pressure in the future,” says Dr. Bond. A study in the Journal of the American College of Cardiology found that patients over 60 with white coat hypertension who had other risk factors for heart disease (like smoking or obesity) were two times more likely to experience a heart attack than those without other risk factors.
Placing a patient on medication for high blood pressure (when they don’t really have it) could cause unnecessary or even dangerous side effects. Alternatively, failing to recognize masked hypertension could delay necessary treatment and allow the condition to progress. Here’s what high blood pressure does to the body if untreated.
Multiple readings at the doctor’s office and at home can help get a more accurate picture of day-to-day BP. (Here’s more info on how to self-monitor blood pressure at home.) Your doc may recommended home BP tests if they’re not convinced they’re getting an accurate reading in the office, according to Dr. Weisfelner Bloom.
Of course, you don’t have to wait for any diagnosis before proactively taking care of your heart. Here are lifestyle tweaks to have a healthier heart.
Franklin SS, Thijs L, Hansen TW, O’Brien E, Staessen JA. White-coat hypertension. Hypertension. 2013;62:982-7.
Study questions effects of white coat hypertension. Washington, DC: American College of Cardiology, 2016. (Accessed on March 12, 2018 at https://www.cardiosmart.org/News-and-Events/2016/11/Study-Questions-Effects-of-White-Coat-Hypertension.)