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What is White Coat Syndrome, also known as White Coat Hypertension?
White coat syndrome is a condition in which a person maintains a normal blood pressure reading at home but an elevated blood pressure at the doctor's office. This is also commonly referred to as white coat hypertension or white coat syndrome.
For many, this is how it feels: the nurse tightens the blood pressure cuff around your upper arm and snaps the Velcro in place. She pumps air into the cuff and he squeezes her arm, slowly suffocating it. You silently question why they didn't come up with a better contraption for measuring blood pressure. Soon the discomfort passes - until the nurse tells you the reading. Your blood pressure is 140/90, clinically considered high systolic blood pressure.
If your reading is high in the doctor's office — but blood pressure monitoring in any other setting is normal — you may be suffering from white coat syndrome, sometimes called white coat hypertension or blood pressure phobia. So what is white coat syndrome? It is an elevated blood pressure reading without the diagnosis of hypertension. The ICD code 10 (diagnostic code) for this condition is R03.0. It is also closely related toiatrophobia, the fear of doctors.
What causes white coat syndrome?
If you're like me, it's not just your blood pressure that goes up around health professionals. My heart is racing, my palms are sweaty, and I seem to forget everything I intended to convey to my doctor. Here are the prevailing theories as to what causes this phenomenon.
Early signs of future problems
Omayo clinicargues that it's an early sign of problems with high blood pressure, and that if you have white coat hypertension, you're at greater risk for cardiovascular problems. Perhaps the temporary increase in blood pressure is enough to contribute to a long-term problem.
However,another reputable surveyshows that the development of cardiovascular disease (in patients who exhibited some white coat effects) was influenced by the age of the patients,nohypertension due to the syndrome. In layman's terms - your blood vessels age with you. The older you get, the more your vessels can constrict and narrow. Consequently, the older you are, the more pronounced your high blood pressure will be when you are exhibiting white coat hypertension.
driven by anxiety
Experts currently agree that you can increase your blood pressure if you are actively anxious. Therefore, being anxious is directly related to monitoring blood pressure in the doctor's office, as well as simply being around medical professionals. People who struggle with this may dread the discomfort that comes with tightening their blood pressure monitor cuff. Maybe it's the fear of what the measurement will show. The anticipation of this is enough to trigger high blood pressure.
If you deal with generalized anxiety outside the context of the doctor's office, you are more likely to struggle with this phenomenon as well. You can explore a qualified therapist near you, or you may prefer the convenience of online anxiety therapy. BetterHelp is ourprovider of choicefor the online route. The platform will match you with one of its 30,000+ licensed therapists based on your preferences.
true phobia
OAmerican Journal of Hypertensionpublished a study in which they sought to show that white coat hypertension is the fear of checking blood pressure. You may actually experience fear and discomfort when measuring your blood pressure. This anxiety can lead to a high blood pressure reading and even avoidance of the procedure. They would, however, argue that this extends beyond high blood pressure readings in a doctor's office and would also extend to readings at home.
Understanding high blood pressure
Let's be honest, "high blood pressure" is an overused term and we should all be familiar with it. However, in reality, few of us really understand what that means. So, here is a brief synopsis of blood pressure:
systolic pressure:According toThe American Heart Association, this is a measure of the blood pressure your blood is exerting against your vessels when your heart is beating.
diastolic pressure:This is the blood pressure your heart is exerting against your vessels when your heart is resting between beats.
High pressure: Healthy blood vessels are flexible and expand and contract with blood pressure. The vessels can narrow and constrict (due to age, illness, or an unhealthy diet), which makes it harder for the heart to pump blood through its vessels. This creates an increase in blood pressure – in other words, high blood pressure. See the table below for normal blood pressure by age, along with minimum and maximum readings.
Is white coat syndrome dangerous?
White coat syndrome can be dangerous. As my doctor pointed out, patients who have high blood pressure readings in a doctor's office often have high readings in other situations they find stressful, leading to high blood pressure more often.
Dr. Randall Zusman, a cardiologist at Massachusetts General Hospital, echoes that sentiment in aharvard resourceabout the potential dangers of white coat hypertension.
Diagnosis
White coat syndrome vs. Hypertension
Your doctor will need to know if you have ongoing hypertension or white coat syndrome occurring in the doctor's office only. according to aEstudo da American Heart Association, at least three days of high blood pressure readings are enough to make a diagnosis.
Your doctor will usually ask you to use a home blood pressure monitor to measure your blood pressure at certain intervals outside the office. Or they may want you to wear an ambulatory blood pressure monitor, which is a wearable device that automatically tracks your readings throughout the day, usually over a 24-hour period in your typical daily routine.
If home blood pressure monitoring shows elevated readings outside the office, your doctor may consider diagnosing you with white coat syndrome.
Treatment
Is there a cure for severe white coat hypertension? Or just the garden variety version? Is it something you can really get rid of? We believe you can overcome the condition with the right protocol. Here are five steps to overcoming white coat syndrome:
- seek awareness
You've already reached the first step. That's itrecognize that you have an abnormal response to something routine.It's common. You're not the only one. But you are acknowledging that you want to change. - exposed therapy
If the instrument itself is the object of your fear, buy an inexpensive blood pressure cuff online that you can use at home. Familiarize yourself with how it works and feels. Wrap the cuff around your arm and secure it with Velcro, then operate it and measure your blood pressure. Hypothetically speaking, the more you become familiar with the cuff and feel comfortable with it, the lower your blood pressure reading should be. The next step is to do this in the office. - Meditation and breathing techniques
Take a few deep breaths while waiting for your appointment. You can distract yourself by playing a game on your phone. Or you can close your eyes and daydream - transport yourself somewhere totally relaxing. Remember that you've done this before and the discomfort is temporary. - Make healthy lifestyle changes
A healthy lifestyle in general can greatly affect your blood pressure. This includes the basics: eating a healthy, well-balanced diet (including keeping salt intake in check), exercising, and avoiding tobacco products. - Access professional help online or in person
Anxiety, depression or other mental health conditions could be the main issues behind white coat syndrome. If you need more than self-help, consider seeking advice from a mental health professional in your area. Alternatively, you canopt for online counseling.
FAQs
How to overcome white coat syndrome? ›
The reverse of "white coat hypertension" (higher blood pressure readings at the doctor's office than outside the clinic setting), "masked hypertension" is normal blood pressure in the doctor's office but high readings outside of the office. Masked hypertension is easy to miss, and can occur during the day or night.
How do you relax with white coat hypertension? ›- Relax. If you're feeling anxious or worried when you sit down to have your blood pressure measured, ask the doctor or nurse to wait a bit so you can calm down.
- Move to a different area. ...
- Practice stress relief. ...
- Change the conversation.
The reverse of "white coat hypertension" (higher blood pressure readings at the doctor's office than outside the clinic setting), "masked hypertension" is normal blood pressure in the doctor's office but high readings outside of the office. Masked hypertension is easy to miss, and can occur during the day or night.
Why do I always get nervous before a blood pressure test? ›Patients often are nervous about what their blood pressure will be when it's measured at their doctor's office, and that anxiety causes their blood pressure to go up. It's known as “white coat hypertension,” and it's particularly common among elderly patients.
How many points can anxiety raise blood pressure? ›The resulting anxiety can elevate blood pressure 10 points or more.” Studies have shown that clinics rarely take two or more blood pressure readings, even though the ACC/AHA guidelines suggest that doing so could reduce the effects of WCH.
How do I get rid of white coat anxiety? ›- Exercising more often.
- Losing weight.
- Reducing how much salt you eat.
- Avoiding the use of tobacco products.
Fully relaxing your body and your mind for a few minutes a day could lower your systolic blood pressure (the top number of a blood pressure reading) by 10 points or more—at no cost, and with no side effects.
What are three easy exercises to lower blood pressure immediately? ›Some examples of aerobic exercise that can help lower blood pressure include walking, jogging, cycling, swimming or dancing. Another possibility is high-intensity interval training. This type of training involves alternating short bursts of intense activity with periods of lighter activity.
What time of the day is blood pressure highest? ›Usually, blood pressure starts to rise a few hours before a person wakes up. It continues to rise during the day, peaking in midday. Blood pressure typically drops in the late afternoon and evening. Blood pressure is usually lower at night while sleeping.
Is white coat syndrome psychological? ›In fact, that sudden rise in blood pressure you experience when you go to the doctor is so common, it actually has a name: White Coat Hypertension or White Coat Syndrome. It's an anxiety-induced blood pressure spike while in a medical environment when high blood pressure is not otherwise an issue for the patient.
How common is white-coat hypertension? ›
Everyone's blood pressure fluctuates constantly throughout the day. But people with white-coat hypertension may experience more frequent and higher spikes. About one in five people has the condition, which doctors typically don't treat with medication.
Will anxiety meds help with white coat syndrome? ›This is often attributed to the anxiety that surrounds doctors and hospital settings. Medications aren't a solution for white coat hypertension.
How bad is white coat syndrome? ›It might mean a risk of developing high blood pressure as a long-term condition. People with white coat hypertension might also have a higher risk of developing certain cardiovascular problems and damage to some organs, compared with people who have steady, optimal blood pressure.
Can therapy help with white coat syndrome? ›If you are having difficulty overcoming your "white coat syndrome," you might want to connect with one of our recommended anxiety disorder therapists. An experienced anxiety disorder therapist's help can be invaluable when addressing and overcoming core fears, such as those regarding health and medical matters.
Which comes first anxiety or high blood pressure? ›Anxiety may lead to high blood pressure, and high blood pressure may trigger feelings of anxiety. Doctors characterize anxiety as feelings of intense worry or fear. It causes many physical symptoms, including increased heart rate and shallow breathing. Periods of anxiety may also temporarily increase blood pressure.
How should you sit when taking blood pressure? ›Sit in a comfortable chair with your back supported for at least 5 minutes before your reading. Put both feet flat on the ground and keep your legs uncrossed. Rest your arm with the cuff on a table at chest height. Make sure the blood pressure cuff is snug but not too tight.
How long to relax before taking blood pressure? ›A rest period of 3 to 5 minutes before blood pressure (BP) measurement is recommended in hypertension guidelines but can be challenging to implement.
Can overthinking cause high blood pressure? ›Overthinking leads to high blood pressure
It can invite stress that can further raise your blood pressure and make you susceptible to heart problems like a stroke or a heart attack.
Still, you can make lifestyle changes to bring your blood pressure down. Something as simple as keeping yourself hydrated by drinking six to eight glasses of water every day improves blood pressure. Water makes up 73% of the human heart,Âą so no other liquid is better at controlling blood pressure.
Should I take blood pressure medication for white-coat syndrome? ›Patients with accurately diagnosed white-coat hypertension who do not have consistently high blood pressure at any other time may not need treatment with medications.
Does holding your breath lower blood pressure? ›
Your blood pressure goes up
Once your body's heart rate goes down during breath-holding, it tries to compensate by raising your blood pressure to get blood pumped to the body. This happens as our blood vessels constrict.
Take a deep breath from your core, hold your breath for about two seconds, then slowly exhale. Pause for a few moments and repeat. Relax! Stress is a key contributor to high blood pressure, so do whatever you can to relax.
What medication is used for anxiety and high blood pressure? ›Propranolol belongs to a group of medicines called beta blockers. It's used to treat heart problems, help with anxiety and prevent migraines. If you have a heart problem, you can take propranolol to: treat high blood pressure.
Does squeezing help lower blood pressure? ›Just squeeze with one hand, using around 30% of your strength, and hold for two minutes (if you're using a hand exercise device, set the resistance to 50%). If this is a struggle, you're probably gripping too tightly or need to turn down the resistance.
Does walking lower blood pressure immediately? ›Ten minutes of brisk or moderate walking three times a day
Exercise lowers blood pressure by reducing blood vessel stiffness so blood can flow more easily. The effects of exercise are most noticeable during and immediately after a workout. Lowered blood pressure can be most significant right after you work out.
Just 30 minutes of exercise every morning may be as effective as medication at lowering blood pressure for the rest of the day.
How long does it take for walking to lower blood pressure? ›It takes about 1 to 3 months for regular exercise to have an impact on blood pressure. The benefits last only as long as you continue to exercise.
Why is my blood pressure all over the place? ›What causes blood pressure to fluctuate from high to low? Anxiety, stress, drugs, alcohol, physical exercise, and a range of medical conditions such as sleep apnea and kidney disease can cause your blood pressure to fluctuate from high to low.
What is ideal blood pressure by age? ›| Women | Men | |
|---|---|---|
| 18-39 years | 110/68 mm Hg | 119/70 mm Hg |
| 40-59 years | 122/74 mm Hg | 124/77 mm Hg |
| 60+ years | 139/68 mm Hg | 133/69 mm Hg |
Blood pressure machines vary, but they're all a type of measuring device, which often have an arm cuff attached to it. The cuff is usually wrapped around your upper arm and filled with air until it feels tight. This can feel uncomfortable but it only lasts a few seconds.
Can I refuse to have my blood pressure taken? ›
Doctors rarely ask permission for routine matters like checking your blood pressure or listening to your lungs, though, on the grounds that they have your tacit consent. They assume you've granted permission for a blood test when you cooperate by rolling up your sleeve for the needle.
Do bananas lower blood pressure? ›Bananas. These are rich in potassium, a nutrient shown to help lower blood pressure, says Laffin. One medium banana provides about 375 milligrams of potassium, about 11 percent of the recommended daily intake for a man, and 16 percent for a woman.
Do a lot of people have white coat syndrome? ›Studies show that nearly 1 in 5 people experience white-coat syndrome. While it usually isn't a cause for concern or treatment, it can be confused with actual, chronic hypertension (or high blood pressure), if not careful.
Why do people get white coat syndrome? ›PHILADELPHIA – White coat hypertension, a condition in which a patient's blood pressure readings are higher when taken at the doctor's office compared to other settings, was originally attributed to the anxiety patients might experience during medical appointments.
Do beta blockers help with white-coat hypertension? ›06.25] BETA-BLOCKERS ARE THE ONLY ANTIHYPERTENSIVE DRUGS THAT BLUNT THE DURATION OF WHITE-COAT EFFECT ESTIMATED WITH AMBULATORY BLOOD PRESSURE MONITORING : Journal of Hypertension.
How do you reverse white coat syndrome? ›- Relax. If you're feeling anxious or worried when you sit down to have your blood pressure measured, ask the doctor or nurse to wait a bit so you can calm down.
- Move to a different area. ...
- Practice stress relief. ...
- Change the conversation.
Similarly, patients with a condition called “masked hypertension” that is the reverse of white coat hypertension – normal blood pressure in their physician's office but high readings at home – have more cardiovascular events than patients with consistently normal blood pressures.
How can I lower my blood pressure before a doctor's appointment? ›Breathe.
Focus on deep breathing for 10-15 minutes before your appointment. The most effective technique for lowering blood pressure is inhaling through the nose and holding for 5-6 seconds, then exhaling through the mouth for one second longer than the inhale.
Patients often are nervous about what their blood pressure will be when it's measured at their doctor's office, and that anxiety causes their blood pressure to go up. It's known as “white coat hypertension,” and it's particularly common among elderly patients.
Is white coat syndrome hereditary? ›Four in 10 Finns have genes that cause "white coat syndrome", research finds. A graduate researcher found that high blood pressure readings at doctors' offices had genetic roots and weren't all in patients' heads.
What are the affirmations for white coat syndrome? ›
“My calm smile reminds me that I'm safe.” “This is easy for me, because I easily relax.” “I'm cool and calm.” “Focusing on my breathing calms me.”
What sedative is used for white coat syndrome? ›Midazolam used as a sedative also has antianxiety effect, and the mechanism is guessed that it minimizes patients' stress, resulting in the stability of blood pressure.
How do you relax so your blood pressure goes down? ›- Adjust your schedule. If you have too much to do, look at your calendar and to-do lists. ...
- Breathe to relax. Taking deep, slow breaths can help you relax.
- Exercise regularly. ...
- Try yoga and meditation. ...
- Get enough sleep. ...
- Change how you see challenges.
- Take a warm bath or shower. Stay in your shower or bath for at least 15 minutes and enjoy the warm water. ...
- Do a breathing exercise. Take a deep breath from your core, hold your breath for about two seconds, then slowly exhale. ...
- Relax!
Stress and Anxiety
If you are experiencing stress immediately before or during a blood pressure test, the spike in cortisol levels will cause your heart rate to increase and could result in a higher blood pressure measurement.
Slow, deep breathing activates the parasympathetic nervous system which decreases the heart rate and dilates blood vessels, reducing your overall blood pressure.
Does drinking water help lower blood pressure? ›Still, you can make lifestyle changes to bring your blood pressure down. Something as simple as keeping yourself hydrated by drinking six to eight glasses of water every day improves blood pressure. Water makes up 73% of the human heart,¹ so no other liquid is better at controlling blood pressure.
How can I calm my blood pressure naturally? ›- Balance nutrients. Go for less sodium (under 1,500 mg per day) and more potassium. ...
- Put probiotics on your side. ...
- Lose even a little weight. ...
- Move more. ...
- Relieve stress.
On average, the top (systolic) number tends to be about 10mmHg higher in a clinic than at home. The bottom numbers tends to be about 5mmHg. Some people's blood pressure will be affected more than others, and if you feel very worried or stressed it could be raised by as much as 30mmHg.
Can you drink water before a blood pressure test? ›Don't eat or drink anything 30 minutes before you take your blood pressure. Empty your bladder before your reading. Sit in a comfortable chair with your back supported for at least 5 minutes before your reading. Put both feet flat on the ground and keep your legs uncrossed.
Does cinnamon lower blood pressure? ›
Cinnamon appears to help dilate and relax the blood vessels, which may help lower blood pressure.
Does lemon water lower blood pressure right away? ›Lemon drink contains traces of several minerals that may be beneficial in lowering blood pressure. Calcium and potassium both can lower blood pressure in those suffering from hypertension. A study suggests that lemon water can help bring the number to the normal range immediately.
What vitamins lower blood pressure? ›Foods high in vitamin C, vitamin E, potassium, selenium or L-arginine are good options if you're looking to lower your blood pressure. Antioxidants protect your cells from damage and can reduce inflammation, which, in turn, can keep blood pressure in control.
What are 7 drinks to lower blood pressure? ›- Water.
- Fruit juices. Pomegranate. Prune. Cranberry. Cherry.
- Vegetable juice. Tomato. Raw beet.
- Tea. Black. Green.
- Skim milk.
A. Blood pressure normally goes up and down 20 or 30 points during the day. Surges up to 200/120 due to stress are impressive, and out of the ordinary.
What time of day should blood pressure be taken? ›At the beginning, measure your blood pressure at least twice daily. Take it first in the morning before eating or taking any medications. Take it again in the evening.