Lots of people have white coat hypertension. Their blood pressure soars when it is measured in the doctor’s office, though it is usually much lower if they measure it themselves at home. How much of a problem is it to have blood pressure high only when you are seeing the doctor?
Should You Treat White Coat Hypertension?
The treatment of white coat hypertension has been controversial; some experts believe it is relatively meaningless, while others think that finding blood pressure high in this circumstance points to underlying cardiovascular problems and should be treated.
Studying White Coat Hypertension:
A new study of 1,300 people with and without white coat hypertension found problems only for older folks with this intermittently high blood pressure. Those who were over 60 who had both white coat hypertension and other cardiac risk factors were twice as likely to have a heart attack or a stroke in the following decade. For younger people and those without additional risk factors, however, white coat hypertension does not appear to be a problem.
Journal of the American College of Cardiology, online, Nov. 8, 2016
Is Your Blood Pressure High at Home?
It seems quite likely that white coat hypertension is related to anxiety or a type of fight-or-flight stress reaction to the smells, sights and sounds of a medical office. Presumably, blood pressure should be much better controlled at home, when you are relaxed. This is one good argument for having a home blood pressure monitor that you can use at different times of the day.
For people whose blood pressure is persistently high, medication is likely to be appropriate; however, even the experts who ran the SPRINT trial are not completely certain whether basing antihypertensive treatment on the blood pressure measurements at home or at work result in fewer cardiovascular complications (Hypertension, online Nov. 14, 2016). It seems that the doctor should rarely prescribe blood pressure medication based on a single in-office measurement, as it might not reflect the patient’s true risk (U.S. Preventive Services Task Force Evidence Syntheses, Dec., 2014).
Medication, Meditation or Both?
You can learn more about the benefits and risks of a number of blood pressure drugs as well as non-drug approaches to lowering blood pressure from our Guide to Blood Pressure Treatment. It is possible that learning deep-breathing exercises or meditation would be useful in overcoming white coat hypertension, though so far as we know that hypothesis has not been tested. Studies have shown that practicing yoga can improve a person’s response to antihypertensive medication (Experimental and Clinical Endocrinology & Diabetes, Feb., 2016).
