White Coat Hypertension

White Coat Hypertension

What is white coat syndrome?

White coat syndrome (also known as white coat hypertension) is a very common condition, in which a patient experiences high blood pressure and heightened anxiety when in a clinical situation, such as a doctor's office. At other times, the patient's blood pressure may be completely normal; however, when visiting a medical professional, the readings are elevated. White coat syndrome could affect as many as 1 in 8 patients to varying degrees.

White coat hypertension can cause strain on your heart from the stress. If this happens often enough or over long periods, this can become a health risk, leading to the risk of long-term damage to your heart. For this reason, it is very important that this syndrome is controlled and treated.

A second condition that some people suffer from is masked hypertension, which is where your blood pressure is normal when taken at a doctor's office, but is higher in different settings.

What causes white coat syndrome?

Feeling nervous when visiting the doctor may seem entirely natural to many patients. However, white coat syndrome can have serious effects. If a patient's blood pressure is elevated, procedures or treatments may be cancelled or postponed, meaning that the patient does not get the medical attention they need. Some estimates say that up to 1 in 8 patients suffer from white coat syndrome to varying degrees.

The name for this condition is due to people being afraid of seeing doctors or medical professionals in white coats, which can raise their anxiety levels.

White coat hypertension causes a temporary increase in your blood pressure. It may not seem particularly dangerous if this only happens occasionally, but some doctors believe that white coat hypertension could lead to real hypertension.

Studies have shown that people who suffer from white coat hypertension are at an increased risk of suffering from:

  • Heart failure
  • Heart attack
  • Stroke
  • Other cardiovascular events

Another study showed that death from heart disease has also been linked with white coat hypertension.

How much does white coat syndrome affect blood pressure?

Of course, the precise effects of white coat syndrome vary from patient to patient. However, an increase in blood pressure is a feature of this condition. The difference in blood pressure when measured at home and at the doctor's office can be vast. At home, the top (systolic) number could be, on average, 10mmHg lower than at the doctor's, while the bottom (diastolic) number could be 5mmHg lower.

These are only averages. Depending on the patient, the difference could be much larger. In fact, some patients could see differences of up to 30mmHg. That makes it difficult for a doctor to measure if a patient really has high blood pressure, or is merely suffering from white coat syndrome.

Does anxiety raise your blood pressure?

Yes. Studies have seen patients fitted with 24-hour blood pressure monitors, which measure the changes in blood pressure over a continuous period throughout the day. Blood pressure readings can change significantly, depending on the levels of anxiety or stress a patient is experiencing. High blood pressure (hypertension) is a permanent problem for some patients, but temporary spikes are common when experiencing anxiety.

White coat syndrome can lead to ongoing problems with high blood pressure, making it important to monitor and treat the issue.

How is white coat syndrome diagnosed?

If your doctor finds that you have a high blood pressure reading, they may ask you to come back and see them again, several times over the next few weeks or months. This will allow them to check the blood pressure measurement over an extended time period, to see if this is a long-term problem.

However, you may suffer from white coat hypertension when you go back to have your blood pressure monitored again. To try and prevent this from happening, a doctor might suggest that you take blood pressure readings outside of the clinical setting.

One way this can be achieved is to have a home blood pressure monitor, which you can purchase online. This will allow you to take accurate blood pressure readings by not having to take them in an environment you find stressful.

Alternatively, they may recommend an ambulatory blood pressure monitor, which you will wear for between 24 and 48 hours. This device tracks your blood pressure every 20 to 30 minutes.

Treatment for white coat syndrome

First of all, it is important for patients to feel comfortable and relaxed before their blood pressure is taken. A patient should try to get to their medical appointment with plenty of time, and sit calmly while waiting to be seen. If white coat syndrome continues, a patient and doctor can discuss the possibilities of home blood pressure monitoring. This could give a more accurate blood pressure reading. It is possible to purchase a home blood pressure monitor, so you can avoid the anxiety that comes with going to the doctor's office or a hospital.

Many treatments involve cooperation between the patient and the medical centre. The medical centre can work to ensure that the patient is always seen by the same doctors and nurses; familiar faces can help lower anxiety.

In some cases, blood pressure medication, or beta blockers such as propranolol, may be required. This should always be discussed with a doctor. Medical professionals are well aware of white coat syndrome and will try to identify it in patients before prescribing any medications. However, if the patient requires ongoing treatment for another condition, and their elevated blood pressure is causing problems, then medication might be necessary.

You may also be able to prevent suffering from the white coat effect by practising relaxation techniques, such as breathing exercises, before you go to visit your doctor.

Frequently Asked Questions

Why do I have white coat syndrome?

White coat syndrome (also known as white coat hypertension) is most commonly caused by anxiety from having your blood pressure reading taken at a doctor's office. The name for this syndrome is taken from the fear a person may experience when seeing doctors and other medical professionals wearing white coats in a clinic setting.

This anxiety can affect your normal blood pressure levels, resulting in a high reading.

A study has shown that a person who suffers from white coat hypertension is at a higher risk of suffering from strokes, heart attacks, heart failure and other cardiovascular events. Another study showed a link between hypertension and death from heart disease.

Alternatively, some people suffer from a condition known as masked hypertension. Masked hypertension is where your blood pressure readings are normal when taken at a doctor's office, but are higher in different conditions.

Is white coat syndrome a real thing?

Yes, white coat syndrome is a real thing, which can cause damage and strain to the heart.

If the hypertension continues in the long term, the level of damage can be increased and become more serious.

The anxiety associated with this condition also raises your blood pressure

Should white coat hypertension be treated?

To avoid the risk of potential long-term damage to your health, which can be caused by excessive strain to the heart, white coat hypertension should be treated.

You can reduce the risk of white coat hypertension by using a blood pressure monitor at home, which will remove the stress of having to visit a clinic setting and help you to remain calm. Your doctor may recommend an ambulatory blood pressure monitor, which you will wear for between 24 and 48 hours, and will take a blood pressure reading every 20 to 30 minutes, for a more consistent and accurate reading.

Beta blockers or blood pressure medicine may be required in some cases to lower high blood pressure.

Is white coat hypertension a long-term problem?

Some doctors believe that white coat hypertension is one of the risk factors of people developing high blood pressure as a long-term medical condition. This is because even a temporary rise in blood pressure may lead to a long-term high blood pressure problem.

If you do suffer from white coat hypertension, you might also be at an increased risk of developing various cardiovascular conditions compared to a person who does not suffer from bouts of high blood pressure. This may also be true for people who are suffering with masked hypertension.

White coat hypertension vs hypertension

White coat hypertension is when high blood pressure occurs at a doctor's office or within another medical setting, such as a hospital. Regular hypertension is when high blood pressure occurs in various places and scenarios, not just limited to a clinical environment.

Around 15 to 30 percent of people who have high blood pressure in a doctor's office actually have white coat hypertension. However, having the white coat effect dose not necessarily mean that you have general hypertension. By the same token, not everyone who has general hypertension will have high blood pressure in a medical setting.

Masked hypertension is a different condition, which can occur when your blood pressure reads normally when in a clinic setting but is higher in non-medical settings.

What is masked hypertension?

Masked hypertension is essentially the opposite of white coat hypertension. This problem arises when a patient has a normal blood pressure reading when it is taken at a doctor's office, but their blood pressure reading is high in other settings, such as at home or at work. Masked hypertension and white coat hypertension are both problematic conditions due to the fact that either of them may lead to an inaccurate blood pressure reading. This may then lead to an incorrect diagnosis and treatment recommendation.

To obtain an accurate blood pressure reading, a sufferer of masked hypertension may require frequent blood pressure monitoring outside of a doctor's office to reach a correct diagnosis. This may involve a doctor giving you a blood pressure monitor to wear at home, which will check on your blood pressure levels throughout the day for a more consistent reading.

How can I prevent white coat syndrome?

The stress and worry that the white coat effect can bring upon a person may be enough for normal blood pressure levels to rise significantly while they are in a doctor's office.

Some of the following techniques may help to lessen the white coat effect and allow your doctor to take a more accurate blood pressure reading:

  • Relaxation techniques, such as breathing exercises or meditation before the appointment can help people to calm down before they go to the doctor. Counting exercises while in the doctor's office, such as counting how many objects they can see in the office, can also help a person who is feeling anxious to take their mind off the blood pressure monitoring.
  • If you are still feeling anxious when you arrive at the doctor's office, take a moment to take a few deep breaths and gather your thoughts. Ask your doctor if you can take a minute or two to calm down to ease into the clinical environment before they apply the blood pressure monitor. Taking a moment to adjust to your environment may make a significant difference to your blood pressure measurement.
  • If the busy activity of being in a clinic setting makes you anxious, you may find that moving to a quieter room in the building to have your blood pressure taken can help you to calm down. Ask your doctor if it is possible to have your blood pressure taken in a different room.
  • Taking a friend to distract you can help some people to relax while they are having their blood pressure taken. Your friend can talk to you about something else while you are having your blood pressure monitored, thus taking your mind off the situation. Alternatively, some people might find it more beneficial to sit in silence and take some deep breaths.

Is white coat syndrome dangerous?

White coat syndrome may not pose an immediate danger to someone's health, but some doctors believe that this problem may cause high blood pressure as a chronic condition if it is not controlled.

White coat hypertension can also pose a danger of you being given an inaccurate diagnosis by your doctor, due to an inaccurate blood pressure measurement. This can result in you being given unnecessary or excessive medication to treat high blood pressure.

If you suffer from either white coat hypertension or masked hypertension, speak to your doctor about home blood pressure monitoring. This will allow your doctor to gain an accurate measurement by monitoring your blood pressure for a prolonged period. It also shows your health care provider if you might be suffering from white coat syndrome.

What else can cause high blood pressure?

If left uncontrolled, white coat syndrome may lead to a chronic high blood pressure problem. However, this condition is not the only contributing factor to high blood pressure (hypertension).

Other common causes of this serious condition include:

  • Being overweight
  • Age (a person over the age of 65 is more likely to suffer from high blood pressure)
  • Smoking
  • Not getting enough exercise
  • Eating too much salt and not eating enough fruit and vegetables
  • Drinking too much alcohol or caffeine-based drinks, such as coffee
  • Having a relative with high blood pressure
  • Being of black African or black Caribbean descent
  • Not getting enough sleep or having a disturbed sleep pattern

Making healthy lifestyle choices like improving your diet, stopping smoking, eating plenty of fruit and vegetables and getting enough sleep can help to reduce your risk of developing high blood pressure.

You should speak to your healthcare provider for more information on ways a person can help to reduce their risks of developing high blood pressure.

Studies have shown that around one case in every 20 of high blood pressure is the result of an underlying health problem.

Health conditions which can cause high blood pressure include:

  • Diabetes
  • Kidney disease
  • Lupus
  • Scleroderma
  • Hormone problems such as an underactive thyroid, overactive thyroid, Cushing's syndrome or acromegaly
  • Long-term kidney infections

This list is not exhaustive.

What are beta blockers?

Beta blockers are a prescription-only medication that are often prescribed for conditions such as high blood pressure, heart failure, angina, heart attacks and an irregular heartbeat.

They usually come in the form of tablets and work to slow down the heart by blocking the action of adrenaline and other hormones.

Beta blockers come in various different types; if you need to be treated for another problem and the white coat hypertension is causing complications, your doctor will prescribe the most appropriate type for you to take for white coat hypertension.

A beta blocker medication will only be prescribed for white coat hypertension if your doctor deems it to be absolutely necessary.

How is hypertension diagnosed?

If a blood pressure monitor shows that your blood pressure is higher than a normal reading, your doctor might get you to come back a few more times over the course of a few weeks or months, so they can monitor it. However, white coat syndrome may reoccur at each of these appointments, making it harder for them to get an accurate reading.

To avoid an inaccurate diagnosis and potentially prescribing you the wrong treatment, the doctor may suggest that your blood pressure reading is taken away from their office.

To do this, they may recommend that you use an ambulatory blood pressure monitor, which you will wear for between 24 and 48 hours. This blood pressure monitor will take readings every 20 to 30 minutes, which will help to get a more consistent and accurate reading. This will help your doctor to reach a solid diagnosis and provide medical advice on the most appropriate treatment.

A second option is for you to purchase a home blood pressure monitor. These can be purchased online or from a registered pharmacy. A home blood pressure monitor will also take a regular measurement and record them for your doctor to refer to.

What health problems can hypertension cause?

High blood pressure (hypertension) rarely has any noticeable symptoms. Patients who suffer from white coat hypertension are also unlikely to exhibit any physical symptoms until a blood pressure monitor shows a high reading.

However, if left untreated, hypertension can pose a real risk to your health, increasing your chance of suffering from serious cardiovascular problems.

Health problems related to persistent hypertension include:

  • Strokes
  • Heart attack
  • Heart disease
  • Kidney disease
  • Vascular dementia
  • Heart failure
  • Aortic aneurysms
  • Peripheral arterial disease

Even reducing your blood pressure a small amount can help to decrease your chances of developing one of these serious problems. It is important you follow your doctor's medical advice if they reach a diagnosis of high blood pressure.

What can I do to reduce high blood pressure if I have it?

There are various changes to your lifestyle you can make to reduce or prevent high blood pressure (hypertension).

These changes include:

  • Stopping smoking (if you smoke)
  • Cutting down on how much alcohol you consume on a regular basis
  • Taking more regular exercise
  • Cutting down on how much caffeine you consume, such as in tea and coffee
  • Reduce the amount of salt you eat in your diet, and improve your diet in general, such as eating more fruit and vegetables
  • Lose weight (if your doctor has told you that you are overweight)

Cutting down on certain things that are related to hypertension can lower your blood pressure and decrease the risks associated with severe problems like heart attacks.

If you do develop chronic hypertension as a result of white coat syndrome, a doctor may recommend a prescription treatment to control your blood pressure, such as a beta blocker medication. You can buy this medicine from Medicine Direct after a diagnosis from one of our registered health professionals.

Medicines to reduce your blood pressure include:

  • Beta blockers
  • Calcium channel blockers
  • Ace inhibitors
  • Diuretics
  • Angiotensin-2 receptor blockers (ARBs)

Is it safe to buy hypertension medication online?

Never order any form of medicine (prescription or non-prescription) online, unless it is from a pharmacy that is registered with the General Pharmaceutical Council (GPhC), like Medicine Direct.

All of our doctors and pharmacists are fully registered with the General Pharmaceutical Council (GPhC), the General Medical Council (GMC) and the Medicines and Healthcare products Regulatory Agency (MHRA). This means that they are legally qualified to prescribe medicines for the medical issues we offer treatment for, just like your local GP.

Each member of our team has also worked in an NHS hospital or other clinic settings.

All of our medicine is despatched from our UK-based Online pharmacy, and if you order by 2pm we can offer you next day delivery.



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