{"id":34733,"date":"2021-06-25T09:30:17","date_gmt":"2021-06-25T13:30:17","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=34733"},"modified":"2023-06-30T17:06:11","modified_gmt":"2023-06-30T21:06:11","slug":"white-coat-hypertension","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/white-coat-hypertension\/","title":{"rendered":"What is white coat hypertension? How do you overcome it?"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">If you\u2019ve ever been a little anxious about a visit to your doctor, you\u2019re not alone. Some people, however, get more than just a little nervous when they enter the exam room: Their blood pressure rises at the doctor\u2019s office, even though it was normal at home. This spike in a medical setting is known as white coat hypertension or white coat syndrome. <\/span><a href=\"https:\/\/www.cdc.gov\/bloodpressure\/measure.htm\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">As many as 1 in 3 people<\/span><\/a><span style=\"font-weight: 400;\"> who have a high blood pressure reading at their doctor\u2019s office might be affected, according to the Centers for Disease Control and Prevention (CDC).<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">But it might not just be a little pre-exam jitters. Learn what causes this rise in blood pressure, what to do about it, and find out if you should be concerned about the implications.\u00a0<\/span><\/p>\n<p><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/PKLTsusSHf0?rel=0\" title=\"YouTube video player\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" allowfullscreen><\/iframe><\/p>\n<h2><span style=\"font-weight: 400;\">What is hypertension?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">According to the American Heart Association,<\/span> <a href=\"https:\/\/www.heart.org\/en\/health-topics\/high-blood-pressure\/understanding-blood-pressure-readings\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">normal blood pressure is 120\/80<\/span><\/a><span style=\"font-weight: 400;\">. That is, you should have a systolic blood pressure of 120 mmHg or less, and a diastolic blood pressure of 80 mmHg or less.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If the top number hovers between 120 and 129 and the bottom number stays under 80, you have elevated blood pressure. When you have a blood pressure of 130-139 over 80-89, you\u00a0 enter the realm of hypertension, or hypertension stage 1. If your blood pressure is 140\/90 or greater, that\u2019s hypertension stage 2. If you wind up in the 180\/120 range, that\u2019s a full-blown hypertensive crisis and you need immediate care.<\/span><\/p>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/blood-pressure-levels\/\"><b>What are normal blood pressure levels?<\/b><\/a><\/p>\n<h2><span style=\"font-weight: 400;\">What is white coat hypertension?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">White coat hypertension describes the phenomenon that occurs when the nurse or medical assistant straps the blood pressure cuff around your upper arm and detects a higher-than-normal reading when at home it is normal. The name alludes to the white lab coats that many healthcare professionals wear on the job. Some patients state that they like coming to the doctor\u2019s office and that they do not feel any anxiety and yet they can still have this condition.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">It\u2019s more common than you might realize. Experts estimate the prevalence of the white coat effect is <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5338886\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">10% to 15%<\/span><\/a><span style=\"font-weight: 400;\"> in the general population. White coat hypertension is highest in children, older adults, women, and those whose blood pressure is just above the normal range.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If you get a doctor\u2019s office blood pressure reading that is higher than expected, don\u2019t panic. If you have normal blood pressure at home, but your blood pressure is high in the doctor\u2019s office, there are several possible causes, according to the CDC:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">If you are talking<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">How you are sitting<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">What you ate, drank, or did before the reading<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">\u201cI make it a point to review with my staff who take my patients\u2019 blood pressure to ensure that the patient is sitting relaxed for at least five minutes without talking and with their back supported on their chair, both feet flat on the ground, and their arm at heart level with a blood pressure cuff that fits their arm,\u201d says <\/span><a href=\"https:\/\/www.aafp.org\/about\/meet-our-leadership\/board\/askari.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Anna Askari, MD<\/span><\/a><span style=\"font-weight: 400;\">, a family physician practicing in Rancho Mirage, California.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">It\u2019s also a good idea to avoid smoking, exercising, and drinking caffeine or alcohol before heading to your appointment\u2014especially within 30 minutes of your blood pressure reading.\u00a0<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Should high blood pressure be treated?\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">First, you need more information to determine if it\u2019s really white coat hypertension, or actual hypertension. \u201cAnytime a patient has high blood pressure, it is important to keep an eye,\u201d says<\/span> <a href=\"https:\/\/online.maryville.edu\/nursing-degrees\/faculty\/mariea-snell\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Mariea Snell<\/span><\/a><span style=\"font-weight: 400;\">, DNP, APRN, FNP-C, the assistant director of the Online Doctor of Nursing Practice program at Maryville University in Missouri. Those with family history of hypertension or cardiovascular disease should be especially diligent.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Home blood pressure monitoring is a good follow-up plan. Your healthcare provider can provide guidance to you to make sure you\u2019re measuring your blood pressure correctly on your own when using a home blood pressure monitor. Your physician might also suggest that you wear an ambulatory blood pressure monitor. An ambulatory blood pressure monitor tracks blood pressure readings over the course of 24 hours. These out-of-office readings provide a better sense of what your blood pressure is really doing.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">If your blood pressure is normal at home&#8230;<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">For many years, doctors shrugged off the in-office spike in blood pressure to nerves. But, recent research suggests that white coat hypertension may be a sign that you&#8217;re at a higher risk for developing sustained high blood pressure\u2014and may be at increased risk for cardiovascular events like heart attack and stroke. Those with white coat hypertension have a three-to-fourfold increased risk of developing hypertension within 10 years compared to normotensive (normal blood pressured) patients.\u00a0<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In fact,<\/span> <a href=\"https:\/\/www.acpjournals.org\/doi\/abs\/10.7326\/m19-0223\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">a 2019 meta-analysis of 27 studies in the <\/span><i><span style=\"font-weight: 400;\">Annals of Internal Medicine<\/span><\/i><\/a><span style=\"font-weight: 400;\"> found that people who had untreated white coat hypertension were at increased risk for developing heart disease. People with untreated white coat hypertension were also twice as likely to die from heart disease when compared to normotensive people\u2014that is, people who have normal blood pressure.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In other words, white coat hypertension is not innocent. It can predict long-term health, according to a <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5338886\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">2017 study in the <\/span><i><span style=\"font-weight: 400;\">Journal of Hypertension<\/span><\/i><\/a><span style=\"font-weight: 400;\">. Maintaining close follow-up with a physician can help you stay in optimal health.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Your healthcare provider may not recommend treatment with medication yet,\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">but still want to monitor you, though, because of the increased risk of developing sustained hypertension in the future.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">If blood pressure is high at home&#8230;<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Interestingly, there\u2019s another phenomenon that\u2019s the opposite of white coat hypertension\u2013but it\u2019s still concerning. It\u2019s called masked hypertension. If you have <\/span><a href=\"https:\/\/www.ahajournals.org\/doi\/10.1161\/hypertensionaha.114.04522\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">masked hypertension<\/span><\/a><span style=\"font-weight: 400;\">, your blood pressure reading at the doctor\u2019s office looks just fine, but you\u2019ll experience increases in blood pressure at other times and in other locations. Mental stress, alcohol use, and smoking are all believed to contribute.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">People who have certain other health conditions like diabetes, chronic kidney disease, metabolic syndrome, shortened sleep time, or obstructive sleep apnea, may be more likely to have higher blood pressure readings at night but not in the doctor\u2019s office, so ambulatory blood pressure monitoring can come in handy for getting more detailed information that may lead to a diagnosis.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If you\u2019re measuring your blood pressure at home and consistently experiencing elevated blood pressure readings outside the doctor\u2019s office, you\u2019ll likely need to go ahead and start treatment.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Treatment for high blood pressure typically includes<\/span> <a href=\"https:\/\/www.singlecare.com\/conditions\/blood-pressure-treatment-and-medications\"><span style=\"font-weight: 400;\">blood pressure medication<\/span><\/a><span style=\"font-weight: 400;\">. According to the <\/span><a href=\"https:\/\/www.heart.org\/en\/health-topics\/high-blood-pressure\/changes-you-can-make-to-manage-high-blood-pressure\/types-of-blood-pressure-medications\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">American Heart Association<\/span><\/a><span style=\"font-weight: 400;\">, the different classes of antihypertensive medications include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/blog\/ace-inhibitors\/\"><span style=\"font-weight: 400;\">ACE inhibitors<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Alpha blockers<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Alpha-2 receptor agonists<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/drug-classes\/angiotensin-ii-receptor-blockers\"><span style=\"font-weight: 400;\">Angiotensin II receptor blockers<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/drug-classes\/beta-blockers\"><span style=\"font-weight: 400;\">Beta blockers<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/drug-classes\/calcium-channel-blockers\"><span style=\"font-weight: 400;\">Calcium channel blockers<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Central agonists<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Combined alpha and beta blockers<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/drug-classes\/diuretics\"><span style=\"font-weight: 400;\">Diuretics<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Peripheral adrenergic inhibitors<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/drug-classes\/vasodilators\"><span style=\"font-weight: 400;\">Vasodilators<\/span><\/a><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Exercise and diet are also key to maintaining your blood pressure at healthy levels. Dr. Askari recommends the <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/heart-healthy-diet\/\"><span style=\"font-weight: 400;\">DASH diet<\/span><\/a><span style=\"font-weight: 400;\">, which includes fruits, vegetables, complex carbohydrates, lean protein, low-fat dairy products, and limited sodium (less than 2500 mg per day).<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">How to overcome white coat syndrome\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Still worried that you\u2019re going to get a high blood pressure measurement at your next doctor\u2019s appointment?<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If you know that you don\u2019t normally have high blood pressure\u2014that is, if you measure your blood pressure at home or in a nearby pharmacy and haven\u2019t noticed an increase\u2014you might try these strategies:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Prepare in advance.<\/b><span style=\"font-weight: 400;\"> You might try some visualization exercises in which you mentally walk through the process of visiting your doctor and having your blood pressure measured.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Take someone with you.<\/b><span style=\"font-weight: 400;\"> You might feel calmer with a trusted friend or family member by your side.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Do some deep breathing exercises. <\/b><span style=\"font-weight: 400;\">A few minutes of mindfulness meditation or even just some deep breathing can help you calm down and feel more centered.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Bring a log of home blood pressure readings.<\/b><span style=\"font-weight: 400;\"> Sit quietly for three minutes before taking the blood pressure. Have the blood pressure cuff at the level of your heart. Take your blood pressure three times back to back.\u00a0 Average the top number (systolic) and average the bottom number (diastolic). Write this averaged blood pressure down. Take your blood pressure twice a week at differing times of day.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Acknowledge your anxiety. <\/b><span style=\"font-weight: 400;\">Let the nurse or office staff know that you\u2019re nervous. They might be able to help you out, or perhaps delay taking your vital signs until later in the visit when you may feel calmer. Or it might just make you feel less anxious to share this information with them.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">\u201cI would recommend going into the office as relaxed as you can,\u201d says Snell. \u201cKnow that no procedures will happen without your consent. Talk to your provider about your concerns so they can help you feel more comfortable.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400;\">It\u2019s useful to know if you have any other risk factors that might raise your cardiovascular risk. And it\u2019s a good idea to think about how you can make some positive changes that could lower your blood pressure, especially if you know you\u2019re at increased risk for cardiovascular disease.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The CDC recommends these<\/span> <a href=\"https:\/\/www.cdc.gov\/bloodpressure\/prevent.htm\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">strategies<\/span><\/a><span style=\"font-weight: 400;\"> to help keep your blood pressure within healthy limits:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Eat a heart-healthy diet.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Exercise regularly.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Stop smoking.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Get enough sleep.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Reduce your alcohol consumption to, on average, less than 1 serving per day for women and less than 2 servings per day for men.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">All of these behaviors can help you improve your health, regardless of whether you have white coat hypertension or not.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>If you\u2019ve ever been a little anxious about a visit to your doctor, you\u2019re not alone. Some people, however, get more than just a little nervous when they enter the exam room: Their blood pressure rises at the doctor\u2019s office, even though it was normal at home. This spike in a medical setting is known [&hellip;]<\/p>\n","protected":false},"author":94,"featured_media":57143,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[8029],"tags":[729,737,11278],"coauthors":[9482],"class_list":["post-34733","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-education","tag-doctor-visits","tag-heart-health","tag-singlecare-for-seniors","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>What is white coat hypertension? 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