White Coat Syndrome – Real? Dangerous? Treatable?
Also called white coat hypertension, this anxiety-related condition was once considered a one-and-done event. Not anymore.
The scenario that was thought to produce white coat syndrome was logical and predictable.
A person whose blood pressure is usually normal has an appointment at a clinic or medical center. There is a bit of anxiety about the visit. Anxiety elevates blood pressure, and having it checked is a routine procedure.
Blood pressure is taken by a physician or other provider who often wears a white coat that symbolizes medical professionalism. The reading is higher than it normally would be when not in a clinical setting. The presumed result: white coat syndrome.
Until recently, white coat syndrome had been considered a temporary spike—no harm, no foul. But not anymore.
Real—Dangerous for Some
White coat syndrome/hypertension was first described more than 40 years ago. Since then, multiple studies have confirmed that it’s a real thing. The original scenario is the same—anxiety can elevate blood pressure in a clinical setting. But current research suggests that white coat syndrome may also be a symptom of something more concerning.
In February 2022, a review of studies in the journal Hypertension became the first to provide evidence that white coat syndrome in patients (with no previous organ damage) had an increased risk of mortality, new hypertension, and new organ damage. This study and others have resulted in a decidedly different approach to white coat syndrome diagnosis and treatment. (https://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.121.18792)
Blood Pressure—How High is Too High?
To be clear, white coat hypertension for most people is still a one-time event that needs attention only in combination with other cardiovascular conditions. According to Cleveland Clinic and other medical centers, the syndrome affects 15-30 percent of people who already have high blood pressure. Patients who don’t normally have high blood pressure can also have the syndrome. (https://my.clevelandclinic.org/health/diseases/23989-white-coat-syndrome)
The definition of high blood pressure has been a moving target and remains a number that your physician determines is right for you. The American Heart Association defines “normal” as less than 120 for the upper (systolic) number; less than 80 for the bottom (diastolic) number. “Elevated” is 120-129 over 79 or less. For numbers defining three advanced stages of hypertension, go to https://www.heart.org/en/health-topics/high-blood-pressure.
The definition of normal can change, depending on a person’s age and health conditions. The AHA’s guideline for those 65 and older is lower than 130/80. Normal for patients over the age of 80 may be higher.
Diagnosis— Multiple Readings
Diagnosis of white coat syndrome requires at least three separate blood pressure readings at a clinic, as well as elevated numbers when checked at home. Home blood pressure kits and regular checks are a good idea, regardless of the white coat issue.
When you take your blood pressure (BP) at home, follow these CDC guidelines: 1) nothing to eat or drink 30 minutes before taking BP; 2) empty bladder; 3) feet flat on the floor, legs uncrossed; 4) arm resting on a surface, chest high; 5) cuff snugly against bare skin, not over clothing; 6) no talking; 7) same time every day; 8) at least two readings, 1-2 minutes apart. (https://universityhealthnews.com/daily/heart-health/how-to-get-an-accurate-blood-pressure-reading/)
Treatment—Lifestyle Changes, Medications
If blood pressure is found to be slightly elevated—your doctor makes that call—you may be asked to consider lifestyle changes. You’ve heard them; all easier said than done. Here’s a review:
- Lose weight.
- Sit less, exercise more.
- Eat more fruits and vegetables, less red meat and processed foods.
- Limit daily salt intake to 2300 mg.
- Don’t smoke.
- Work on managing stress. (https://universityhealthnews.com/daily/stress-anxiety/how-to-deal-with-stress/)
If your blood pressure is more than slightly elevated, your doctor may prescribe medications to lower it. Examples are diuretics, alpha- and beta-blockers, ACE inhibitors, and calcium blockers. The Hypertension study mentioned earlier also found that patients with white coat syndrome who take medications to control blood pressure don’t have elevated risks of cardiovascular disease.
Antihypertensive drugs carry risks, mostly mild, for some patients. Ask your doctor about medications that might lower your blood pressure too much. Hypotension, as it’s called, could cause dizziness, lightheadedness, passing out, weakness, nausea, and other symptoms.
How low is too low? The National Library of Medicine says that while there is no universally-accepted standard, blood pressure readings under 90/60 indicate hypotension.
White Coat Syndrome—Answers and Actions
It’s real—well documented. It can be dangerous for some, leading to a variety of conditions that require medical intervention. High blood pressure, whether conventional or white coat, is treatable. It starts with lifestyle changes, and for more serious cases, advances to effective and safe antihypertensive medications.
Don’t dismiss white coat hypertension if it shows up at your next doctor’s appointment. Have it checked or regularly check it yourself.
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