Overcoming White Coat Syndrome: 

The Complete Guide

What is White Coat Syndrome, aka White Coat Hypertension?

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 syndrome is R03.0. It is also closely related to iatrophobia, the fear of doctors.

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.


Normal and abnormal blood pressure chart readings

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.


Anxiety Driven

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.


True Phobia

Woman overcoming white coat syndrome and getting blood pressure checked


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 higher 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.

How to Overcome 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:


  1. 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.
  2. If the instrument itself is the object of your fear, buy a cheap blood pressure cuff online. 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.
  3. 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.
  4. If the unknown results are what you fear, remind yourself that your health comes first. Blood pressure readings are a standard way to make sure your heart and cardiovascular system are healthy.

  5. 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


Pro Tip

(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

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