Overcoming White Coat Syndrome

Doctor in white coat taking a patient's blood pressure

The accuracy of your blood pressure reading in the doctor's office can be affected by factors such as your emotional state, physical activity, pain level, and intake of caffeine or nicotine.

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Factors such as your emotional state, physical activity, pain level, and intake of caffeine or nicotine can drive up your blood pressure in the short term, making it difficult to get an accurate reading in the doctor’s office. This condition is referred to as the “white-coat” effect or “white-coat” syndrome.

To overcome this white coat syndrome and reduce the likelihood of misdiagnosing hypertension, the AHA/ACC guidelines and the USPSTF recommend that any high blood pressure readings in the clinical setting be confirmed by measurements done away from a hospital or your physician’s office before making a diagnosis of hypertension or initiating treatment.

One way to accomplish this task is with ambulatory blood pressure monitoring (ABPM). This 24-hour monitoring provides a broader, longer-term picture of your day-to-day blood pressure, as opposed to the one-time snapshot afforded by an office blood pressure reading.

ABPM includes a cuff similar to the blood pressure cuff used in a standard office visit. The cuff is connected to a portable device that you clip to your belt or carry in your pocket. The ABPM systems are lightweight and designed so there is little or no interference with your daily life. The monitor takes blood pressure readings at fixed intervals (usually 20 to 30 minutes) over 12 to 24 hours while you go about your regular daily activities and during sleep.

In addition to the individual readings, daytime averages, and nighttime averages, a 24-hour average is computed.

In its recommendation, the USPSTF cited studies showing that “there was significant discordance between the office diagnosis of hypertension and 12- and 24-hour average blood pressures using ABPM, with significantly fewer patients requiring treatment based on ABPM. Elevated ambulatory systolic blood pressure was consistently and significantly associated with increased risk for fatal and nonfatal stroke and cardiovascular events, independent of office blood pressure. For these reasons, the USPSTF recommends ABPM as the reference standard for confirming the diagnosis of hypertension.”

ABPM is prescribed when “white-coat” syndrome is suspected. It also may be used to assess resistant hypertension and for patients who experience labile hypertension, a wide fluctuation in blood pressure readings.

To learn about high blood pressure symptoms, risk factors and treatment, purchase Managing Your Blood Pressure at www.UniversityHealthNews.com

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Jim Black

Jim Black has served as executive editor of Cleveland Clinic’s Men’s Health Advisor newsletter since 2005. He has written about prostate diseases, men’s health, cardiovascular disease, cancer, and a wide … Read More

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