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What is White Coat Syndrome, aka White Coat Hypertension?
White coat syndrome is a condition in which a person maintains a normal blood pressure reading at home, but an elevated blood pressure at the doctor's office. This is also commonly referred to as white coat hypertension or white coat syndrome.
Here's how it feels to many: The nurse tightens the blood pressure cuff around your arm and slaps the velcro into place. She pumps air into the cuff and it squeezes around your arm, slowly suffocating it. You silently question why they haven’t invented a better contraption to measure blood pressure. Soon the discomfort passes—until the nurse tells you the reading. Your blood pressure is reading at 140/90, clinically considered high systolic blood pressure.
If your reading registers high at the doctor's office—but blood pressure monitoring in any other setting it is normal—you may be suffering from white coat syndrome, sometimes referred to as white coat hypertension or blood pressure phobia. So, what is white coat syndrome? It is an elevated blood pressure reading without the diagnosis of hypertension. The ICD 10 code (diagnosis code) for this condition is R03.0. It is also closely related to iatrophobia, the fear of doctors.
What Causes White Coat Syndrome?
If you’re anything like me, it’s not just your blood pressure that spikes around health care professionals. My heart races, my palms are sweaty, and I seem to forget everything that I meant to relay to my Doctor. Here are the prevailing theories about what causes this phenomenon.
Early Signs of Future Problems
The Mayo Clinic argues that it’s an early sign of issues with high blood pressure and that if you experience white coat hypertension you’re at a higher risk for cardiovascular problems. Perhaps the temporary rise in blood pressure is enough to contribute to a long-term problem.
However, other reputable research shows that developing cardiovascular disease (in patients who exhibited some white coat effects) was influenced by the age of the patients, not the high blood pressure due to the syndrome. In layman's terms—your blood vessels age with you. The older you get, the more your vessels can contract and narrow. Consequently, the older you are, the more pronounced your high blood pressure is when you are exhibiting white coat hypertension.
Experts currently agree that you can drive up your blood pressure if you are actively anxious. Therefore, being anxious is directly related to blood pressure monitoring at the doctor's office, as well as simply being around medical professionals. People who struggle with it may fear the discomfort that comes with the tightening of the blood pressure monitor cuff. Perhaps it is the fear of what the measurement will show. The anticipation of this is enough to set off high blood pressure.
If you deal with generalized anxiety out of the context of the doctors office, you are more likely to struggle with this phenomenon as well. You can explore a qualified therapist near you, or you may prefer the convenience of online therapy for anxiety. BetterHelp is our provider of choice for the online route. The platform will match you to one of their 30,000+ licensed therapists based on your preferences.
The American Journal of Hypertension published a study in which they sought to show that white coat hypertension is a fear of having one’s blood pressure checked. You can indeed experience fear and discomfort while having your blood pressure taken. This anxiety can lead to a high blood pressure reading and even avoidance of the procedure. They, however, would argue that it extends beyond high blood pressure readings in a doctor's office and would extend to readings in one’s home as well.
Understanding High Blood Pressure
Let’s be honest, “high blood pressure” is a term that’s thrown around a lot and we should all be familiar with it. However, in reality, few of us truly understand what it means. So, here is a short synopsis of blood pressure:
Systolic Pressure: According to The American Heart Association, this is the measurement of the blood pressure your blood is exerting against your vessels when your heart is beating.
Diastolic Pressure: This is the blood pressure your heart is exerting against your vessels when your heart is resting between beats.
High Blood Pressure: Healthy blood vessels are flexible and expand and contract with your blood pressure. Vessels can narrow and constrict (from age, disease, or unhealthy diet) which makes it more difficult for the heart to pump blood through your vessels. This creates an increase in blood pressure—in other words, high blood pressure. See the chart below for normal blood pressure by age, along with minimum and maximum readings.
Is White Coat Syndrome Dangerous?
White coat syndrome can be dangerous. As my doctor pointed out, patients who have high blood pressure readings in a doctor's office often have high readings in other situations they find stressful, leading to high blood pressure more often.
Dr. Randall Zusman, a cardiologist at Massachusetts General Hospital echoes that sentiment in a Harvard resource on the potential dangers of white coat hypertension.
White Coat Syndrome Vs. Hypertension
Your doctor will need to know whether you have ongoing hypertension, or white coat syndrome, occurring only at the doctor's office. According to an American Heart Association study, at least three days' worth of high blood pressure readings is enough to make a diagnosis from.
The doctor will commonly ask you to use a home blood pressure monitor to measure your blood pressure at certain intervals away from the office. Or they may want you to use an ambulatory blood pressure monitor, which is a wearable device that automatically tracks your readings throughout the day, usually for a 24-hour period across your typical daily routine.
If your home blood pressure monitoring indicates elevated readings away from the office, your doctor may consider diagnosing you with white coat syndrome.
Is there a cure for severe white coat hypertension? Or just the garden variety version? Is it something you can truly get rid of? We believe you can beat the condition with the right protocol. Here are five steps to overcoming white coat syndrome:
- Seek awareness
You’ve already reached the first step. It’s recognizing that you have an abnormal response to something routine. It’s common. You aren’t the only one. But you are acknowledging that you want to change.
- Exposure therapy
If the instrument itself is the object of your fear, buy a cheap blood pressure cuff online that you can use at home. Familiarize yourself with how it works and what it feels like. Wrap the cuff around your arm and velcro it in place, then operate it and measure your blood pressure. Hypothetically speaking, the more you familiarize yourself with the cuff and become comfortable with it the lower your blood pressure should read. The next step is having this done in-office.
- Meditation and breathing techniques
Take some deep breaths as you wait for your appointment. You can distract yourself by playing a game on your phone. Or you can close your eyes and daydream—transport yourself somewhere that is utterly relaxing. Remind yourself you’ve done this before and that the discomfort is temporary.
- Make healthy lifestyle changes
An overall healthy lifestyle can greatly impact your blood pressure. This includes the basics: Eating a healthy, well-balanced diet (including keeping salt intake in check), exercising, and avoiding tobacco-based products.
- Access Professional Help Online or In-Person
Anxiety, depression, or other mental health conditions can be the core issues behind white coat syndrome. If you need more than self-help, consider seeking counseling from a mental health professional in your area. Alternatively, you can opt for online counseling.
(If you can pinpoint your fear and it is more closely related to doctors, read our article—4 Steps to Overcoming Iatrophobia — The Fear of Doctors