White Coat Hypertension: A Cause for Concern?

By David Lawrence, MD, FACC, Cardiologist – Virtua Cardiology

For many people, a visit with your health care provider can be nerve-racking. Have I gained too much weight? Will she say I have some terrible disease? Will I need to take medication?

If the stress of a medical appointment causes a spike in your blood pressure compared to readings taken at home or elsewhere, you may have “white coat hypertension.”

These temporary increases in blood pressure were thought to be little cause for concern. However, recent research is challenging those opinions. 

A 2019 study published in the Annals of Internal Medicine found people with untreated white coat hypertension had a 36% higher risk of heart attack, stroke, and other heart-related events compared to those whose blood pressure readings were normal at the doctor's and at home. They were also twice as likely to die of heart disease.

White coat hypertension shouldn't be dismissed. If seeing a health care provider increases your blood pressure, so could other stressors, like being stuck in traffic, rushing to get the kids off to school on time, or dealing with a difficult coworker.

Your Blood Pressure

When the heart beats, it creates pressure that pushes blood through your arteries, veins, and capillaries. This pressure is the result of two forces: the blood pumping out of the heart and into the arteries (systolic pressure) and the heart resting between beats (diastolic pressure).

Normal blood pressure is considered less than 120/80 mmHg.

Hypertension is when your blood pressure is consistently too high. While it has no outward symptoms, high blood pressure can weaken vessel walls over time and put you at risk for heart disease, stroke, kidney disease, and vision loss.

A single high reading does not mean you have hypertension. Everyone’s blood pressure fluctuates throughout the day. If you do have high readings in the office, we may recommend home monitoring so we can get a better idea of what is happening during a typical day. 

Measuring at Home

When monitoring your blood pressure at home, the American Heart Association recommends:

  • Use the correct size of an automatic cuff-style (upper-arm) monitor. Don’t wear the cuff over clothing and make sure its bottom edge is directly above the bend of your elbow.
  • Be still. Within the 30 minutes prior to taking a reading, don’t exercise, drink caffeinated beverages, or smoke. Before you start, empty your bladder and rest quietly for at least five minutes.
  • Sit correctly. Keep your back straight and supported. For example, sit on a dining room chair rather than a sofa. Place both feet flat on the floor. Support your arm on a flat surface, such as a table, keeping your upper arm at heart level. 
  • Measure at the same time every day. Take multiple readings and record the results.

Take Control of Your Health

Looking at the readings, we can correlate variations in blood pressure with particular activities, which will help in diagnosis and the development of a treatment plan. 

That may include exercising, losing weight, eating a heart-healthy, Mediterranean-style diet, managing stress, and not smoking. If those efforts are not sufficient, we also may prescribe medication. These may include diuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and calcium channel blockers.  

The earlier we can catch and diagnose your hypertension, the more successful we can be in reducing your chances of having a heart attack or stroke.

Total Heart Care Near You

Looking for a cardiologist? Get an appointment with a Virtua heart specialist within 48 hours. Call 888-847-8823.

Updated January 11, 2021

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