primary care doctor blood pressure

Is White-Coat Hypertension Dangerous?

Your family practice physicians at The Medical Group of South Florida will take your blood pressure reading at the beginning of every visit, because high blood pressure, or hypertension, has often been called “the silent killer”: It usually has no symptoms, and can trigger a host of health issues.

High blood pressure can weaken blood vessels, leading to stroke; damage and narrow arteries, causing heart attacks, and heart failure, as well as aneurysms; damage kidneys; and lead to cognitive impairment.

Sometimes we encounter a problem, though. Some of our patients are exceptionally nervous on entering our doctors office, either because they’re worried about the possibility of their symptoms indicating a serious disease, or because they’ve had unhappy encounters with doctors in the past and these memories make them especially uneasy.

For these people, their blood pressure readings can be abnormally high at the outset of their visit, and this phenomenon is so common it even has a name: white-coat hypertension, or white-coat syndrome.

It’s understandable that encounters in medical settings might produce higher-than-normal blood pressure readings, because blood pressure tends to vary throughout the day, even minute-by-minute, depending on stresses encountered, foods eaten, state of mind, and so on.

Based on this, in the past it was thought that white-coat hypertension was benign—and, for the most part, it is. But recent studies have shown that it can predict future hypertension and heart issues, because those who react so strongly to a medical encounter are more likely than the average person to also have higher-than-normal blood pressure in response to other stressful stimuli.

So what is normal? The upper limit of healthy blood pressure is considered to be 135/85. Readings higher than that are thought to be Stage 1 hypertension. But if you think your higher reading in our offices might be the result of white-coat syndrome, tell us. We can help you ascertain whether this condition is harmless or something to watch more carefully.

The first step is to take your blood pressure again at the conclusion of your visit. If we have successfully alleviated your concerns, it should be lower. But again, this doesn’t mean there’s no cause for further monitoring. On the other hand, we don’t want to prescribe medication for hypertension if the cause is transient, because this can cause low blood pressure, and lead to lightheadedness and fainting.

Therefore, the next step we will recommend is at-home monitoring with good-quality equipment. This entails taking three readings at one-minute intervals at the same time each day, either early morning or in the evening, and calculating the average. Sit calmly for 15 minutes beforehand to allow blood pressure to stabilize. Be sure to empty your bladder before taking the reading, and don’t wear tight sleeves. Arm position is important: The arm on which you’re taking the reading should be at heart level, parallel to the ground, with the elbow slightly flexed.

If your readings at home are consistently normal, we will recommend continued monitoring of your numbers, because if you have white-coat syndrome, you are still at slightly elevated risk of developing high blood pressure in the future. We will also recommend various relaxation techniques, and various dietary and exercise regimens to ensure your blood pressure stays within the healthy range. This includes a diet low in fats and salt and high in fruits and vegetables.

Finally, we will take the time to discuss with you the reasons behind your white-coat anxieties, helping to allay any fears you may have about coming to see us.