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Dr.Armughan Riaz
M.B.B.S, Dip Card
Consultant Cardiologist


White Coat Hypertension

What is white coat hypertension causes treatment. What to do if your blood pressure raises in doctors clinic or hospital environment.

White Coat Hypertension

We know that Hypertension is the medical term for high blood pressure, and ‘white coat’ points to a doctor’s white coat, and therefore a clinical or medical environment.  Simply put, white coat hypertension means having a high reading only when your blood pressure is measured away from your normal home environment, usually in a doctors clinic or surgical hospital.

People with consistently high readings 140/90mmHg or above do have hypertension but there are a few people who will have white coat hypertension.  People with white coat hypertension have high readings 140/90mmHg or above only when they have their blood pressure measured at their doctors surgery or in a clinic, and have normal blood pressure readings outside a clinic environment. A small number of people may have white coat hypertension that goes unrecognised which could mean being wrongly diagnosed as having hypertension and receiving unnecessary medication. A small number of people that are diagnosed with high blood pressure may have white coat hypertension. If you have ‘mildly’ raised blood pressure, ie, up to 160/99mmHg, then white coat hypertension could account for this level of blood pressure.  Above 160/99mmHg it is likely that even if you took into account a rise in blood pressure because of anxiety, it would still be high.  For example, if you had a systolic reading of 180mmHg in the surgery and took into account a possible white coat effect of 30mmHg then it means your systolic reading would be 150mmHg, which is still a high reading.


Causes of white coat hypertension?

Normally blood pressure goes up and down throughout the day and night in everyone.  For example, when you are in pain or very excited, when you have just exercised or when you are angry your blood pressure rises; when you are resting or getting sleep then your blood pressure falls down to normal values.
White coat hypertension is caused by anxiety, when your body stimulates your ‘flight or fight’ response.  Many people who have white coat hypertension knowthat they feel nervous or anxious, but many others may think that they are relaxed when, in fact, they are not. It can affect anyone, young or old, male or female and some people find that anxiety can raise their blood pressure by as much as 30mmHg on the systolic blood pressure.  Being relaxed, in a quiet environment and being given reassurance can help to reduce this anxiety.


How do I know if I have white coat hypertension?

If we see, there are no symptoms of white coat hypertension, you won’t feel unwell if you have it.   The only way to find out if you are affected is to have your blood pressure measured outside your doctor’s surgery or clinic.  There are two ways of doing this- Taking readings yourself at home and or Ambulatory Blood Pressure Measurement (ABPM) - sometimes also called 24-hour monitoring of blood pressure. Only a few people will be asked to have Ambulatory Blood Pressure Measurement, which is a test to see what your blood pressure is like over a period of 24-hours. In this procedure, a small portable monitor takes readings regularly and automatically over a day and a night.  Your doctor can then look at an average of the day-time readings and this should show whether you have a normal blood pressure at home.  If the average reading is 135/85mmHg or less then it is normal.  Some doctor’s surgeries now have ABPM equipment or alternatively you may need to go to your local hospital outpatients department to have the machine fitted.  .

Your doctor may also ask you to use an automatic or a semi-automatic blood pressure machine to take a series of readings yourself at home. Some doctors and clinics will lend you a monitor, usually for two weeks, and ask you to take readings at certain times of the whole day.  After you have taken these readings your doctor or nurse will analyse them and work out an average. You can also buy a blood pressure monitor to use at home, to monitor your blood pressure levels. 


What to do if I have white coat hypertension?

Studies have shown that if you have white coat hypertension you are at less risk of heart disease or stroke than someone who has sustained high blood pressure, but at a greater risk than someone who has normal blood pressure at all times.  For this reason it is important to make sure that you have your blood pressure checked regularly – at least once a year.  This is to make sure that if your blood pressure does start to rise, you can take steps to lower it at your ealiest.


Why Does white coat hypertension Matter?

If you really don’t have high blood pressure and just have white coat hypertension, you might start taking medicine that does more harm than good. Taking medication unnecessarily is never wise.

It is seen that Many people with white coat hypertension go on to develop high blood pressure in the future.  For this reason, particularly if you have other risk factors like smoking, or high cholesterol diabetes family history, your doctor may advise you to take treatment imidiately.

You may adopt a healthy lifestyle to bring your BP down.  This means eating a diet low in fat and salt and high in fruit and vegetables, being active and the right weight for your height and not drinking alcohol excessively. You can also buy a blood pressure monitor to use at home, to monitor your blood pressure levels.

Finding out whether you may have white coat hypertension is important as it can make the difference between being treated, or not, and can affect other aspects of your life such as insurance and work. If you are concerned, talk to your doctor or nurse.

In summary, white coat hypertension is a very real phenomenon, and for many people is no cause for alarm. But for some, it may be hiding a more serious problem that, if not properly evaluated, can lead to unfortunate complications.


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