The White Coat Effect

Anxiousness in a Clinical Setting Elevates BP Levels

​The sight of a policeman creates fear among people whether they have committed a mistake or not. The same is the case of white coat syndrome. Here, a person’s blood pressure readings show higher values when inspected by a white coat doctor in a hospital setting irrespective of their usual blood pressure levels.

But higher than normal readings in medical settings than when taken at home are indicative of an underlying blood pressure condition. When BP readings are taken at home, the systolic pressure is usually 10mmHg lower than it would be when taken by a doctor and 5mmHg lower on the diastolic number. Few people have greater variations in readings.

People at Risk for White Coat Hypertension
A person might be diagnosed with white coat hypertension when he/she has a high blood pressure reading only when the person is in a medical setting. The same blood pressure readings may be normal when they are taken at home.

No person’s blood pressure remains the same throughout the day and goes up/comes down depending on what job he/she does and also based on external factors. Although we don’t notice it, the reality is that most of us feel tensed in a medical setting than in a setting that we are familiar with. Also, the white coat effect affects some people’s blood pressure readings more than others raising systolic blood pressure by as much as 30mmHg. This makes it even more difficult to come to a conclusion whether the person actually has blood pressure or is simply experiencing white coat hypertension.

This condition more frequently affects women, older adults, nonsmokers and recently diagnosed patients with hypertension. Misdiagnosing people with white coat hypertension as truly having hypertension can even cause loss of employment for the doctor as the patient would be subjected to lifelong drugs and medications with potential side effects.
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Diagnosis
Any person can be affected by white coat hypertension, but the problem as such is less prevalent. Even without yourself realizing it, you may be nervous when scheduled for a blood pressure reading to be taken at the hospital. The best way to check whether you have white coat hypertension or not is to compare the readings taken at the clinic with that taken at home. There are two ways to do this:

Home Readings Help in Comparison

Readings taken at home: Technology and science have enabled humans to measure their own blood pressure in the comfort of their home. This is also helpful to the doctors to compare the readings taken outside clinical settings against theirs. Maintain a record journal of your daily BP readings to know how they differ on a day-to-day basis.
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24-hour BP monitoring: This helps to know more about the details of how your blood pressure changes throughout the day. The individual will be provided with a small blood pressure monitor that has to be worn throughout the day to measure and note BP readings day and night. The readings are stored in memory and all you need to do is wear the monitor. Either you can call someone to fit the monitor or go to the nearby outpatient department to have one fitted.
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Dealing with White Coat Hypertension
As anxiety and tension are the root causes of this problem, it should be possible to avoid it if you make up your mind and keep yourself relaxed. Try to rest for a while before having your BP measured or if you are already late for the appointment, take a moment to calm down and have your blood pressure readings reach their normalcy again. You can also divert your attention onto various other things at the hospital setting to stop worrying about your readings or move onto a quiet room devoid of nurses, doctors or receptionists working busily on their chores. When all these don’t help you in any way, try to sit down with your doctor and look out for solutions. The physician might ask for the blood pressure readings to be taken at home or start monitoring you more closely for some time.

If you have been diagnosed with high blood pressure and you doubt whether it could be white-coat hypertension, please remember that your physician would have considered all possibilities before giving his/her final diagnosis. On the contrary, there are ample chances that people with white coat hypertension can be diagnosed with high blood pressure in a matter of few months too. It is important to check your blood pressure readings with a physician (every 6-12 months) to ensure that you have not entered the high blood pressure phase. Blood pressure can be controlled with a healthy diet, proper lifestyle changes and regular physical activity. Please get in touch with registered dietitian nutritionists at www.firsteatright.com for a personalized diet and lifestyle plan suiting your body type. 

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