What Is White Coat Hypertension

Hypertension is a condition where blood exerts too much pressure against the walls of blood vessels. The American Heart Association states that normal systolic blood pressure should be 120mm Hg or lower while diastolic blood pressure should be up to 80mm Hg.¹

When the top number increases to 120–129 and the bottom number is below 80, you have elevated blood pressure at that time. 

If the blood pressure reads 130–139 over 80–89, you have stage one high blood pressure or mild hypertension. 

When it reaches 140 over 90 or greater, you have stage two high blood pressure or moderate hypertension. 

A blood pressure reading of 180/120 or more means a person has dangerously high blood pressure and needs immediate care.

To be diagnosed with regular high blood pressure, you need to show consistently high blood pressure results, regardless of the environment. However, there are instances when blood pressure rises for some people only in certain situations, like in a doctor's office.

What is white coat hypertension?

White coat hypertension refers to higher blood pressure readings when in a medical setting or doctor's office.² This might happen even if your blood pressure is normal in other settings, such as at home.

The phenomenon draws its name from the white lab coats historically worn by healthcare professionals while on duty. Even people who say that they don't feel anxious when visiting the doctor's office may have this condition.

What causes white coat syndrome?

Many parts of the experience of seeing your doctor can cause anxiety, such as the fear of a potential diagnosis, the tightening of the cuff around your upper arm, or seeing medical staff wearing a white coat.

In some people, this anxiety is high enough to increase blood pressure. However, you may experience the occasional rise in blood pressure during a doctor's appointment due to other reasons, such as work stress, failure to take blood pressure medication for several days, consuming foods high in sodium (salt), or ingesting a lot of caffeine.

How serious is white coat hypertension?

White coat hypertension is not a serious condition. However, it can be an early sign of potential future health problems. 

If your visit to the doctor can cause anxiety to the point of showing physical symptoms, it would be reasonable to assume that other situations might trigger similar symptoms when you aren’t wearing a cuff to prove it.

Rapid increases in blood pressure due to a visit to your doctor (or any other cause) may cause strain on your heart, and, in the long term, the strain causes damage that may become severe.

Can you cure white coat hypertension?

Currently, there is no cure for white coat hypertension. However, try regularly monitoring your blood pressure levels at your workplace or home and comparing the results with the blood pressure readings taken by your doctor. This will show whether the doctor’s reading was a case of white coat hypertension or if you may have chronic high blood pressure.

If you detect white coat hypertension, you can treat it with lifestyle changes.

Are there complications of having white coat hypertension?

The complication of having white coat hypertension is hypertension itself.³ Although the increased blood pressure could be due to the anxiety of visiting the doctor, it could indicate future hypertension. 

These occasional strains on the heart could also lead to other health problems if left untreated.

Another side effect of white coat syndrome is the likely misdiagnosis of ongoing hypertension leading to unwanted or unnecessary medication. 

So, frequent blood pressure monitoring at home is crucial to easily and accurately inform the doctor about the possible presence of white coat hypertension.

How to overcome white coat hypertension?

White coat hypertension is a condition you can overcome. Let’s look at some ways to manage the condition.

Check what you consume before the doctor's visit

Of course, you cannot undo all the diet choices you have made over a lifetime in a single day. However, avoiding fatty foods, especially those with high sodium levels, for one or two days before the appointment will help.

Avoid tobacco or large amounts of caffeine for at least one hour before the appointment.

Consider afternoon appointments

Blood pressure tends to be high in the morning. You can schedule your appointment in the afternoon and avoid the spike in blood pressure without the need to do anything else.

Take a brisk walk

A 15–20-minute brisk walk can produce the same results as relaxation breathing techniques but with the additional benefit of physical activity and a change of scene. It helps activate rhythmic breathing, which lowers blood pressure by calming the stress response in the body.

Take a nap before the appointment

A nap can help reduce strain and pressure on your heart. However, ensure it does not go beyond one hour.

Hydrate

Water helps dilute sodium, which plays a part in elevating blood pressure. Little sips throughout the day can keep you hydrated, which is beneficial to the body’s healthy functioning. 

Follow a healthy diet

Following the Dietary Approaches to Stop Hypertension (DASH) diet will keep you fit and your heart healthy. 

Request a quiet room

You may require a quiet space during your appointment. A still environment can help you forget about the medical setting you are in, thus calming you down.

Try relaxation techniques

Deep meditation and advanced breathing techniques while taking your mind off the blood pressure test can be a great way to manage white coat hypertension. 

A 4-7-8 breathing technique where you inhale air through your nose for four seconds, hold the breath for seven seconds, and breathe out via your mouth for eight seconds can also help. Repeat the cycle four times to distract your attention away from the blood pressure test. 

The technique also helps to calm the body's fight-or-flight response and reduces its natural inflammatory reaction to stress hormones.

While it may seem that talking can help keep you calm, it may raise your blood pressure by a few points. So, unless you are answering a question, you may like to keep any conversation at bay until your healthcare provider has taken the reading.

How to diagnose white coat hypertension

Diagnosing white coat hypertension may be a challenge. When your doctor finds the initial blood pressure reading is high, they will often ask you to return for another measurement a few weeks later.

People with white coat hypertension may experience high blood pressure for the second visit. If so, your doctor may recommend taking readings using a blood pressure monitor device at home or in a pharmacy.

Home blood pressure monitoring

You can buy or rent a home pressure monitor from a pharmacy or medical supply company, or even from your general practitioner.⁴

Ensure you seek assistance in finding the correct device and a well-fitting cuff. If the arm-cuff does not fit properly, it may lead to incorrect blood pressure readings.

You can use the machine to take frequent blood pressure readings and record them for your healthcare provider to review at your next visit.

Tips for monitoring blood pressure at home

Follow this advice to get a consistent blood pressure reading:

Check it first thing in the morning

Food and beverages containing caffeine can lead to a temporary increase in blood pressure levels. So, take the reading in the morning before tea, coffee, or breakfast.

Relax

A few deep breaths can help you relax before you take the reading. Sit quietly and ensure you don't close your legs and ankles.

Keep your arm in position

Place the cuff directly on the skin and sit up straight. Rest your arm at heart level, on a table next to you or a cushion, for example.

Follow the device's directions

Blood pressure monitors have operating instructions that may differ from one brand to another. Therefore, ensure you read the directions of your device and operate it accordingly.

Ambulatory blood pressure monitoring

Ambulatory blood pressure monitoring involves taking blood pressure readings every 20–30 minutes during the monitoring window, usually 24-48 days. 

You strap the device on for one or two days and it monitors your blood pressure readings and sends them to the doctor.

Generally, the only difference between home and ambulatory blood pressure monitors is a personal choice. However, some people may prefer the ambulatory blood pressure monitor since it takes the blood pressure readings even during activities such as sleep and exercise.

What is the treatment plan for white coat hypertension?

Treating white coat hypertension involves several lifestyle adjustments. These lifestyle changes can help maintain your blood pressure within healthy limits and help improve your general health even when you don't have white coat syndrome.⁵

Exercise regularly

Regular physical activity is an easy, effective solution to lower your heart rate and blood pressure.⁶

Consider aerobic exercises such as cycling, dancing, jogging, swimming, or walking. Talk to your doctor about developing an exercise program that is right for you.

Consume healthy foods

Switch to a DASH diet. This contains fruits, vegetables, whole grains, and low-fat dairy products while reducing saturated fats and cholesterol. 

The DASH diet is advised by cardiologists for heart health and lowering blood pressure.

Limit alcohol intake

Avoid drinking excessively, i.e., more than two drinks a day for women and more than one a day for men. A single drink equals one of the following:

• 12 ounces of beer

• Five ounces of wine

• 1.5 ounces  of 80-proof liquor

Excessive alcohol consumption adds several points to your blood pressure reading.

Quit smoking

Smoking raises blood pressure.⁷ Quitting smoking has multiple health benefits, including:

• Lowering blood pressure over time

• Reducing the risk of heart disease

• Improving overall health

Reduce stress

Stress can play a part in elevating blood pressure. Even occasional stress can contribute to higher blood pressure, especially if you try to cope with the situation by smoking, drinking alcohol, or eating an unhealthy diet.

Stress could be due to an illness, work, finances, or family issues. Take time to find out what is causing your stress and try healthier coping mechanisms. For example:

• Focus on issues you can control

• Schedule time to do the activities you enjoy

• Change your expectations

• Avoid stress triggers

Lower sodium intake

Reducing the amount of sodium in your diet helps reduce blood pressure and improve heart health. You can achieve this by:

• Reading food labels to shop for low-sodium alternatives

• Avoiding processed foods

• Not adding salt to the food you prepare at home

You can cut back on the amount of salt you use by using spices and herbs to add flavor.

The lowdown

White coat hypertension, or the temporary increase in blood pressure when you visit the doctor's office, may not always signify a bigger problem. However, it is worth monitoring since the occasional rises in blood pressure may increase the risk of more serious long-term health problems.

Managing your blood pressure before an appointment and home monitoring is helpful for the doctor to confirm whether you do have white coat hypertension. 

Fortunately, a treatment plan involving lifestyle changes can help overcome white coat hypertension and improve your general health.