White Coat Hypertension...What is it??

What is one of the first things that happen when you walk in a Dr.’s office? Your blood pressure is taken. It is one of several vital signs. If your values are above a certain rate consistently, you are said to have high blood pressure which is a condition that may need to be treated. But did you know that there are some people that have high blood pressure only in the medical office? Sounds funny, but it’s true. Being professionals, we have to give it a snappy name so we call it White Coat Hypertension. It’s when your blood pressure is elevated but only when you’re at the Dr’s office. In other words, normal blood pressure at home, high blood pressure readings when in the physician’s office. Believe it or not, this is actually quite a common scenario.

So how does someone recognize and diagnose this condition? First, you need at least three separate office visits where your blood pressure measurements are high, typically above 140/90. Second, you should have at least two sets of measurements more in the normal range, below 140/90. These should be taken at home or even at your local pharmacy.

Alternatively, there is one device that you can wear which takes your blood pressure automatically that is called an Ambulatory Blood Pressure Monitor or ABP Monitor for short. (And no, this doesn’t mean you have to ride around in an ambulance all day long while it takes your blood pressure!) Measurements taken with the ABP Monitor are considered the gold standard in making a White Coat Hypertension diagnosis since it affords multiple readings taken over a 24 hour period. It records your blood pressure at different intervals as you are going about your daily routine. This allows for readings all through the day and at night as well as monitoring the difference between awake and sleeping pressures.

Ok, so you’ve done all of that and now you have all your blood pressure readings and they are still on the high side. What now? If the ABP Monitor readings average above 140/90, it may indicate the need for an ultrasound of the heart, also called an echocardiogram. What this procedure does is look for blood pressure in the heart, also known as hypertensive heart disease. A physician will also look for other complications such as eye involvement or kidney disease.

Finally, what all that means is this… those with White Coat Hypertension are at a lesser risk than those with sustained hypertension or even hypertensive heart disease.

Dr. Frank
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