We all have that friend or relative who refuses to believe that he or she has hypertension. “My blood pressure is always normal until I step into the doctor’s chamber,” they say.
Interestingly, they could have been right all along and might not be suffering from hypertension at all. But they could be having a variant of hypertension — white coat hypertension, where an individual has elevated blood pressure only in the presence of doctors or medical personnel.
“The name ‘white coat hypertension’ came from the doctor’s white coat, and people diagnosed with this condition tend to have elevated blood pressure only in front of a doctor or inside a hospital,” says Dr Prashanth Pawar, consultant, interventional cardiology, Fortis Hiranandani Hospital, Vashi, Maharashtra. “Their BP will be lower or normal at home or elsewhere.”
White coat hypertension could be a prelude to full-blown hypertension in some people, and hence needs to be properly diagnosed and addressed in a timely manner.
What causes white coat hypertension?
Dr Pawar says white coat hypertension is a marker for cardiac risk. If left unmanaged without proper support and intervention, it could even lead to stroke and heart disease, he adds.
“Stress and anxiety are the main causative factors for white coat hypertension,” says Dr Pawar. “Stress itself could trigger release of hormones like adrenaline which could make blood pressure shoot up — sometimes by as much as 20% more than the regular rate.”
Dr Ravindranath Reddy DR, consultant cardiologist, BGS Gleneagles Global Hospital, Bengaluru, says that people with a poor response to stress management are more prone to white coat hypertension.
“Multiple studies state that a few of these people diagnosed with white coat hypertension have higher chances of developing permanent hypertension later on,” he says. “It is also true that everyone with white coat hypertension need not develop permanent hypertension also.” White coat hypertension is usually seen in young and middle-aged people (30 to 50 years old), Dr Reddy adds.
Dr Pawar says that many people rush to the hospital, braving traffic and other factors. They get worked up and will have elevated blood pressure even before they sit down for a checkup. “Nowadays BP and other vitals are checked at a desk outside the doctor’s room,” he adds.
As per European Society of Hypertension and European Society of Cardiology norms, blood pressure above 140/90 is considered to be elevated.
Diagnosis of white coat hypertension
Dr Reddy says that if a person claims that he or she feels high BP in the presence of a doctor, then multiple blood pressure readings are taken at different intervals to check the variations.
“Usually, they should be taken at least thrice at different times,” he says. “In some patients, we also go for home monitoring of blood pressure with an ambulatory blood pressure monitor (ABPM) for 24 hours.”
Dr Pawar points out that an ABPM is a portable continuous monitor that records your BP every hour during the day and every two hours at night.
“If the home readings remain normal and only the hospital readings are elevated, then we can confirm it is white coat hypertension,” Dr Reddy says. If any variations are seen, further tests like ECG and echo are conducted to confirm once again that the BP variation is not due to any underlying condition, he adds.
Dr Pawar says that if the blood pressure is high in the home readings too then it means the person could be hypertensive, and further examinations are required.
Why an accurate diagnosis is important
Dr Reddy says that it has to be confirmed without doubt that the individual has regular hypertension or white coat syndrome before deciding on the further course of action. An accurate diagnosis is important because it decides whether or not an individual should be put on medication for hypertension.
Both experts point out that while someone with hypertension might need medication, someone with whitecoat medication need not take medicines.
“Most hypertensive medications are long-term ones and hence we have to be fully sure whether someone is actually hypertensive or just having a bout of white coat hypertension,” Dr Pawar says.
Is white coat hypertension a long-term health problem?
Dr Reddy says that in case of those with white coat syndrome, no medication is required as, technically, they do not have a blood pressure issue.
“In most cases, it is poor reaction to stress and anxiety,” Dr Reddy says. “We generally suggest relaxation techniques and de-stressing tips including yoga and meditation,” Dr Reddy adds.
Dr Pawar adds that dietary alterations and lifestyle modifications are also suggested so as to avoid cardiac complications in the future. “White coat hypertension is like the yellow light at a traffic signal,” he says. “It means it’s time to be cautious and adopt healthier practices like avoiding smoking and alcohol.”
‘Actually, it’s a common condition’
Both Dr Reddy and Dr Pawar say that white coat hypertension is quite common, and they regularly get patients experiencing it.
“If I see 25 patients a day, on most days either one or two people come to me with white coat hypertension,” Dr Pawar says. “I also feel there is a slight increase in white coat hypertension post [the Covid-19] pandemic, mainly because of the stress and anxiety.”
Takeaways
White coat hypertension means having elevated blood pressure readings in the presence of doctors or medical personnel. It is caused by stress and anxiety, and doesn’t mean that the individual has hypertension. But since it is a marker for future cardiac complications, it needs to be monitored and addressed on time.
