How high blood pressure in the office can be white coat hypertension

“But doc, my blood pressure is always normal at home.”  I wish I had a dollar for every time I have heard that line and I know it is true.

When some patients come to see me, their blood pressure is abnormally high (above 130/90) and this is known as “white coat hypertension.”  Although it has been thought to be from anxiety about seeing the doctor, even long established patients who have no conscious anxiety can exhibit elevated blood pressure in the office.

Because blood pressure naturally fluctuates and the office visit is not a “normal” setting,  it is important for patients who have hypertension (high blood pressure) to have their own BP cuff at home.  Now that devices are automated and easy to use, everyone with hypertension should be monitoring their BP in the comfort of their own home.  I advise multiple readings over a week at different times of day.  Get a reading when resting and when rushing around.  Take the BP after you exercise and after a meal.  It is important to keep a log and write it down.  Only then can we see patterns and know if the blood pressure is controlled or not.

Blood pressure readings in the doctors office are not necessarily the most accurate.  Patients are often rushed trying to get parked and in on time.  Medical assistants can use the wrong size cuff or not position the arm correctly.  Auscultation (listening) is not very accurate due to errors.  It is the multiple readings over time that give a more accurate picture of blood pressure control.

High blood pressure in the office can be true hypertension or it can be “white coat hypertension” that is usually controlled at home.  If a patient is on blood pressure medication and has controlled BP at home, I will not add more medication just because they are elevated in the office.  If a patient has not been diagnosed with hypertension and the BP is elevated in the office … that patient is advised to get their own home cuff and return with readings for us to review.  This way we can minimize unnecessary and expensive medication and make sure we are protecting the patient as well.

Toni Brayer is an internal medicine physician who blogs at EverythingHealth.

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