High Blood Pressure or
White-Coat Syndrome?

By Todd Welliver, MD

Should the patient's blood pressure remain elevated with a second reading, the physician may suggest self-monitoring.

White-coat syndrome or white-coat hypertension is a situation where a patient has high blood pressure readings in a physician's office, but nowhere else. White-coat syndrome is thought to be caused by anxiety that some people experience when visiting the doctor. It is up to the physician to determine if this is just an occasional episode or if the patient is suffering with a condition of sustained high blood pressure.

Untreated high blood pressure is an important cause of vascular disease. It can lead to the obstruction of arteries throughout the body -- especially in the heart, brain, legs, eyes and kidneys. Hypertension is a major silent killer because it usually doesn't cause symptoms until it has wreaked its vascular havoc.

White-coat syndrome actually occurs in only 10 to 12 percent of hypertense patients. There are two common scenarios that a physician may face when trying to diagnose hypertension:

1. The patient blames his or her high blood pressure reading on nerves and declines treatment, so the physician puts off prescribing medication, although it may be needed.
2. The patient's high blood pressure reading in the office is presumed to be the patient's usual blood pressure reading, and medication is prescribed, which may not be needed.

A recent report recommends that patients rest for at least five minutes -- seated in a chair, feet on the ground -- before having their pressure test repeated. It's important to consider that stresses exist throughout everyday life. If a patient responds to stress with episodic elevations in blood pressure, and this occurs frequently enough, it can cause damage to the blood vessels, so it needs to be treated.

Monitor Closely
Should the patient's blood pressure remain elevated with a second reading, the physician may suggest self-monitoring. The patient can purchase a blood pressure cuff or have his or her pressure tested at a blood pressure machine commonly found in the pharmacy or supermarket. The patient should record his or her blood pressure on multiple occasions throughout the week, keeping a log of the day and time that the reading was taken. After viewing the log, the physician can be more certain of the prescribed treatment.

Your physician may also suggest a 24-hour ambulatory pressure monitor, which is a cuff worn for at least a 24-hour period that records your blood pressure every half-hour throughout the day and night. Please be advised that your insurance company may not cover the cost of this type of monitoring, although it is the "gold" standard for diagnosing white-coat syndrome.

As with any patient diagnosed with hypertension, patients with white-coat syndrome need to be monitored closely and should be particularly mindful of the importance of maintaining an ideal body weight, avoiding overuse of salt and sodium and following an exercise program.

Todd Welliver, MD, earned his medical degree from the Ross University School of Medicine in New Jersey. He completed his medical school training in Baltimore, working with affiliates from Johns Hopkins and University of Maryland medical schools. He completed a residency in internal medicine at the Drexel University College of Medicine, formerly the Medical College of Pennsylvania Hospital and Hahnemann University Hospital. Dr. Welliver offers 24-hour ambulatory blood pressure monitoring at his office, located at 440 State Road 7, Suite 101, in Royal Palm Beach. Dr. Welliver is currently accepting new patients. To make an appointment, please call 561-337-6944.

Wellington Regional Medical Center, 10101 Forest Hill Blvd. Wellington, FL 33414 (561) 798-8500