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White-Coat Hypertension: Is My Doctor Making My Blood Pressure Rise?

Lately, I can feel my heart begin to race like mad the minute I step into a doctor's office and, not surprisingly, my blood pressure has been high. Is there a white-coat syndrome? If so, why at the age of 55 am I so uneasy about a doctor's visit?

A
Answer (Published 1/25/2002)

Revised 4/10/2009

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Yes, there certainly is a well-recognized phenomenon called "white-coat hypertension" in which blood pressure increases when it’s taken in the doctor’s office. The anxiety that causes your blood pressure to rise is probably a conditioned response to seeing the doctor and, perhaps, to what physicians have told you on past visits. The big question, of course, is how do you know for sure that your blood pressure goes up only in the doctor’s office? Since high blood pressure itself generally doesn’t cause any symptoms, there’s no way for you to confirm that your pressure is otherwise normal unless you’re checking it regularly. To be sure that the high blood pressure readings you’re getting during your physician visits are the transient results of your anxiety, I suggest you rent or purchase a blood pressure monitor, if you don’t already own one, so you can keep track of it at home. If you’re doing your own monitoring, check your blood pressure at least twice a day, at random times, and keep a log of your results.

Keep in mind that you’re not alone. A study published in the December 8, 2008 issue of the Archives of Internal Medicine found that nine percent of patients participating in the clinical trail showed signs of white coat hypertension. The lead author Gbenga Ogedegbe, M.D., now an associate professor at New York University School of Medicine, concluded that doctors shouldn’t be taking blood pressure readings. Instead, these measurements should be done by automated devices.

Earlier research found that white-coat hypertension is much less likely to occur when a nurse rather than a doctor measures blood pressure. However, the study also concluded that to get a truer picture of blood pressure, the patient should wear an ambulatory device that takes readings throughout the day and night.

Another intriguing finding indicates that white-coat hypertension may be a sign of early heart damage and raises the question of whether it should be treated. In December 2001, the Archives of Internal Medicine published the results of a study by a group of Italian researchers that found enlargement of the heart’s left ventricle was common among patients with white-coat hypertension.

This change may indicate an increased risk of heart attack and stroke. So far, there’s no medical consensus on whether this new evidence means that patients with white-coat hypertension should automatically be treated for high blood pressure. Either way, I think it’s still a good idea to eat a wholesome diet and maintain a healthy weight, exercise regularly, and practice breathing exercises and other relaxation techniques. Since white-coat hypertension may indicate an exaggerated nervous response, it may suggest you need to find a way to manage stress.

Andrew Weil, M.D.

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