Often, when patients come to my office, I will get high blood pressure readings; however, when they go home and measure it themselves, their blood pressure reading is normal. Occasionally they’ll ask if the instruments in my office are off, or if my staff misread the result.
It’s neither of those. The actual problem is a common condition called white coat hypertension. It’s used to describe people whose anxiety over a visit to a physician, dentist, or other medical facility evokes a fight-or-flight response and, as a result, their blood pressure readings go up.
A Closer Look at High Blood Pressure Readings at the Doctor’s Office
Given the above definition, you might think that white coat hypertension is harmless. However, that may not be the case. Research has shown that abnormally high blood pressure readings in a medical setting could be more than just a benign byproduct of anxiety. White coat hypertension could be a precursor to high blood pressure and other cardiovascular risks.
A Danish study published in the Journal of Human Hypertension found a heightened cardiovascular event risk for patients with white coat hypertension over a 10-year period. A Japanese study reported in the journal Hypertension Research suggests that high blood pressure readings caused by white coat hypertension contributes to carotid arteriosclerosis. And in another Japanese medical report—based on eight years of observation—researchers suggest that white coat hypertension is a “transitional condition to hypertension” and may carry a “poor cardiovascular prognosis.”
Tips to Avoid High Blood Pressure Readings
Blood pressure readings are like the Dow Jones average; they go up and down, even in a five-minute interval. Remember, your heart is a pulsating, dynamic organ, so your blood pressure will vary, sometimes as much as 20 to 30 mm/Hg in successive readings. How can you prevent high blood pressure readings? The key is to relax.
When taking a resting blood pressure reading, I don’t let people talk. Talking will drive your numbers up. (Air traffic controllers as a group have higher-than-normal blood pressure. They’re under enormous pressure, and they talk all the time.) I also avoid taking BP if the patient rushed to my office, especially if he or she was caught in traffic, if the outside temperature is very cold or if some emotional stress issues are ongoing. Even a cup of coffee just prior to the test can change the data.
What do your high blood pressure readings tell you? Readings where the top number (systolic pressure) is 130–139 or the bottom number (diastolic pressure) is 85–89 should be monitored carefully. Readings consistently above 150/90 are a risk factor for heart attacks.
Now with that said, I also have to tell you that white coat hypertension is still poorly understood. But my professional opinion is that you should err on the side of caution. If you experience high blood pressure readings at the doctor’s office, I suggest you take the following steps to help get it under control and avoid potential problems.
- Practice stress-reduction techniques regularly.
- Watch your salt intake.
- Consider blood pressure–friendly supplements on a daily basis.
More Dr. Sinatra Advice on Understanding Blood Pressure
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