White coat hypertension, a condition in which blood pressure is elevated at the doctor’s office or clinic but not at home, is a fairly common condition. Sometimes it can result in people taking medication they may not need. Some of our readers have suggested that simply getting to the doctor might be enough in some cases to make blood pressure spike. Does that happen to you?
How Could Getting to the Doctor Affect Blood Pressure?
Q. I have found that blood pressure measurements are usually taken soon after you arrive at the doctor’s office. Part of white coat hypertension could be that you’re stressed from getting to the office (finding parking, walking, filling out forms). Taking the blood pressure later in the visit might provide a more useful reading.
Getting to the Doctor Early:
A. Thanks for this advice. Another reader shared her solution to this challenge:
“I resolved my white coat hypertension by arriving well ahead of my appointment. I get a coffee and then have time to sit and relax a little with my iPad or a magazine. This gives me a chance to recover from the stress of heavy traffic so I can avoid the anxiety of being late.”
We are glad this works for you. For others, we would discourage the coffee. Some research suggests that drinking coffee can increase blood pressure for a few hours (Clinical Nutrition, online, March 31, 2016). While that is not enough to be a problem long-term, it could certainly affect blood pressure measurement in the office.
There is not currently consensus among physicians about how white coat hypertension should be treated (Current Hypertension Reports, Nov., 2016). People with this condition seem to be at intermediate risk-right in between those with unquestioned high blood pressure, which increases the risk of heart attacks and strokes among other dangers, and those with normal blood pressure that doesn’t need any treatment. People who do have elevated blood pressure only at the clinic should probably stay in touch with the health care provider for regular monitoring. That way, if occasional high blood pressure becomes more frequent, someone will note it and initiate treatment.
Measuring Blood Pressure Properly:
Even if the stress and hassle of getting to the doctor doesn’t mess up your blood pressure noticeably, it is still important for it to be measured properly. That means:
- Sitting on a chair with back support,
- with your feet on the floor, not dangling
- with your arm supported at heart level
- and not talking.
It is surprising how frequently these basics of blood pressure measurement are overlooked or ignored. In addition, the blood pressure cuff needs to be the correct size. People with unusually thick arms need a larger cuff; those with extremely thin arms may need a smaller cuff than normal.
Masked Hypertension:
There is a condition that is the counterpoint to white coat hypertension. In masked hypertension, blood pressure measurements may be normal at the doctor’s office, but is often elevated in other situations. This condition can be difficult to diagnose, but it affects between 10 and 15 percent of the population (Circulation, Dec. 6, 2016; European Heart Journal, online Nov. 10, 2016). That is why we urge everyone to have a home blood pressure monitor and use it regularly.
You can learn more about white coat hypertension and blood pressure control, as well as guidelines on proper measurement of blood pressure, in our Guide to Blood Pressure Treatment.
