White Coat Hypertension

[Reader's Digest Magazine] If you’re so nervous during a medical checkup that your blood pressure skyrockets, you may have what’s known as white-coat hypertension.

That means your blood pressure may only be high temporarily when your doctor tests it. Your blood pressure also changes temporarily when you’re physically active, under stress or feeling emotional, but white-coat hypertension occurs specifically from nervousness in the presence of the doctor.

Blood pressure of less than 115/75 mm Hg is normal; between 120-139/80-89 is considered prehypertension; and above this level (140/90 mm Hg or higher) is considered hypertension. According to the National Hypertension Association, Inc., 20-35 percent of people who have hypertension when a doctor measures their pressure have normal blood pressure when they measure it at home or elsewhere in a relaxed environment.

SHOULD YOU BE CONCERNED?

There are two potential problems associated with white-coat hypertension. The first problem is that if your doctor diagnoses hypertension based on his readings when you really only have white-coat hypertension, you may end up taking drugs you don’t need, says Simeon Margolis, M.D., Ph.D., a professor of medicine and biological chemistry at the Johns Hopkins School of Medicine. Hypertensive drugs are not without side effects, he says, and they probably aren’t necessary for most people whose blood pressure is normally low.

The second problem is that if you assume you have white-coat hypertension rather than true hypertension, you may end up ignoring potential problems. Some studies suggest white-coat hypertension poses no increased risk, at least over the short term. Other research suggests white-coat hypertension may be a transitional condition to real hypertension. “That leads some people to think that even if your blood pressure is only high when you visit a doctor, you might be in trouble and you ought to do something about it,” says Margolis.

Adding to the confusion, the data on hypertension and the success of drug treatments come from doctors’ office measurements, says Margolis, which undoubtedly include people who have white-coat hypertension. So the experts don’t always agree on whether to treat white-coat hypertension medically or to wait and see if true hypertension develops. Everyone’s situation is different, so discuss your specific concerns with your doctor.

If you have white-coat hypertension, you shouldn’t ignore several high blood pressure readings. If white-coat hypertension turns into real hypertension, it can lead to stroke, heart attack and kidney failure, which kill almost a million people each year and injure another million. Hypertension is often called the “silent killer” because it has no symptoms. Nearly one-third of people who have hypertension don’t know they have it, according to the American Heart Association.

If you think you might have white-coat hypertension rather than hypertension, here’s what you can do.

AT THE DOCTOR’S:

• Get the nurse to take your blood pressure. “For some reason it’s often not as high with the nurse as with the doctor,” says Margolis.
• Get tested at the end of the visit. If your doctor takes a quick history and immediately slaps on the blood pressure cuff, you may end up with an abnormally high reading, says Margolis. You may find it easier to relax at the end of the visit.
• Expect variations. For best results you should sit quietly for at least five minutes before your blood pressure is tested, and then have it tested again at the end of your checkup, says Margolis, who suspects few doctors or nurses take the time to do this. “There’s no doubt some people have elevated blood pressure only in a doctor’s office, but that’s often the result of measurement errors.”

ELSEWHERE:

• Test at home. “You can buy an accurate blood pressure cuff for under $100 that allows you to test your own blood pressure without any help from anyone else,” says Margolis. A device called a sphygmomanometer comes with a cuff, a pressure registering system and sometimes a stethoscope and comes in three varieties: mercury, aneroid and automatic. For information on the advantages and disadvantages of each type, visit the American Heart Association website (americanheart.org).
• Get automated. Some doctors have a device available that automatically records blood pressure intermittently for 24 hours.
• Improve lifestyle habits. If your numbers are elevated at the doctor’s office, they may be through the roof in seriously stressful situations. To help keep your blood pressure in the good range, don’t smoke, get regular exercise, manage your weight, limit alcohol to no more than one drink a day if you’re a woman or two if you’re a man, eat a healthy diet low in saturated fat and cholesterol, and go easy on the salt.

Kathy Summers is a freelance health, nutrition and fitness writer based in Half Moon Bay, CA.

First published in Reader’s Digest magazine [Copyright protected]