What is white coat hypertension?

Dr. Frank J. Ammaturo, MD
Cardiologist (Heart Specialist)

If you get stressed out when you're at the doctor’s office, you may have an elevated blood pressure that we call white coat hypertension. This is because stress can affect blood pressure, and when you're under stress, your body will respond by elevating blood pressure.

In other words, you may have a falsely elevated blood pressure if you're stressed out at a doctor’s office. If you think you have white coat hypertension, you should consider buying a home blood pressure monitor to see what your blood pressure is like outside the doctor’s office.

Dr. Ozgen Dogan
Cardiologist (Heart Specialist)

The type of high blood pressure called "white coat syndrome" measures normal at home but high at the doctor's office. It's more common among women. It does need to be treated, however, because this type of high blood pressure harms your organs in the long term.

A 24-hour blood pressure monitoring device is very useful for diagnosis when it comes to "white coat syndrome" because it takes a visit to the doctor's office out of the equation. The monitor is attached to you for 24 hours and automatically records your blood pressure at regular intervals. While awake, average blood pressure should be below 135/85. While asleep, average blood pressure should fall below 120/75. If your blood pressure doesn't fall when you're asleep, you're at risk for heart disease.

A small number of people experience "white coat hypertension," which is very elevated blood pressure when visiting their healthcare professional while blood pressure at home is normal. At home, you can check your blood pressure in a setting that's more comfortable for you to get a more accurate reading.

High blood pressure is typically defined as a reading of 140/90 mmHg (millimeters of mercury) on two or more visits to the doctor’s office. But in some patients, the doctor’s office reading may be higher than that person’s blood pressure as measured at home. This is referred to as white-coat hypertension. Research suggests that the temporary spike in blood pressure is a stress response in those patients.

If your physician thinks your elevated blood pressure may be white-coat hypertension, he or she may have you monitor your blood pressure on an ongoing basis at home and keep a log, or it may be suggested that you wear a monitor that can take periodic readings. Based on these readings gathered over time, your physician can recommend beginning medication (or adjusting current dosages) and appropriate lifestyle changes. 

Some research studies have found that patients with white-coat hypertension are more likely than people with normal blood pressure to develop high blood pressure. If you have white-coat hypertension, you may still wish to speak with your physician about ways you can maintain a healthy blood pressure level over the coming years.

Up to one-fifth of individuals with hypertension will show accentuation in the doctor's office, or white coat hypertension. The level of risk of complications (including heart attack, stroke, and kidney disease) due to such episodic blood pressure elevation appears to lie in between people with totally normal blood pressure and those with sustained elevations. White coat hypertension often coexists with milder levels of sustained blood pressure elevation.

Some people are told they have white coat hypertension. This means that the person’s blood pressure may be elevated at the doctor’s office or clinic but not at home or at other times. Measuring the blood pressure outside the doctor’s office can help discover this discrepancy and possibly eliminate unnecessary treatment. In addition, you can wear a simple blood pressure monitor that automatically measures the blood pressure day and night to obtain an accurate reading. It’s better to do try wearing a monitor and be aware of blood pressure discrepancies than to be in the dark when it comes to knowing your real risk for hypertension and the resulting serious problems. 

White-coat hypertension is stress-related high blood pressure that occurs, for example, when you go to the doctor. It does require treatment. Stress occurs daily in all of our lives, and none of us can predict, control or prevent it. When our bodies are stressed, our blood pressure naturally goes up. When we have high blood pressure, it goes up higher than it should (above 140/90 mm Hg). People who have white-coat hypertension should be treated so their blood pressure does not get dangerously high under stress.

Uncontrolled high blood pressure can lead to eye and kidney disease, strokes and heart attacks. Complications of untreated hypertension include death. It is vitally important to treat high blood pressure, even if it is not always high. Blood pressure naturally goes up and down. However, the highs should remain within the normal range. There are some exceptions to this rule, including a few conditions that require a slightly elevated blood pressure for stable health. Ask your doctor about your target blood pressure.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.