What’s White Coat Hypertension(and why it could be important for you to
know)?
When you go to visit a doctor , how do you feel? Relaxed as if you were going to see a
movie? Looking forward to it as a trip to your favourite restaurant? No, more likely you
feel nervous, anxious and tense. Is it any wonder then that your blood pressure is higher
than normal? Doctors are beginning to realize that in many instances the blood pressures
recorded in their clinic of their patients are not a true reflection , but are artificially high.
The term for this condition is White Coat Hypertension, and it affects upto 25-30% of
people who visit a doctor. It affects both first time visitors as well as known patients of
high blood pressure.
Imagine the consequence of a diagnosis of High blood pressure to a perfectly normal
person? A lifetime of medication, the psychological burden of being labeled as having a
disease.. and all because of a mistaken diagnosis? Well doctors now realize that being in
a hospital or clinic environment may not the best place to record blood pressures and
various techniques and measures have been advocated to unmask this problem and obtain
a more true picture of the actual situation.
First it may not be the best idea for a doctor to record the blood pressure, rather a less
threatening figure might be a nurse or even an automated record with an electronic
device. Make the patient relax by sitting quietly and reading a book or magazine while
the BP is being recorded. These are a few techniques to minimize the White Coat effect
in a hospital or clinic setting. Recording the blood pressure in the patients home
environment reflects a more accurate picture and should be used to guide diagnosis as
well as treatment.
There are now available devices that record the blood pressure over the entire 24 hours
and these are called Ambulatory Blood Pressure Recorders. Basically the device consists
of a recorder connected to a BP cuff which automatically inflates at random times once or
twice an hour. The readings are interpreted in a graphic and tabular form. Certain normal
patterns have been identified : basically the blood pressure is seen to dip at night and rise
early in the morning. The average daytime , night time pressures as well as the 24 hour
average are assessed and High blood pressure is diagnosed if daytime average
exceeds135/85 mmHg and/or the 24h average exceeds 130/80 mmHg.
It is now understood that this type of recording not only helps in diagnosis but also gives
important prognostic insights and also helps in guiding treatment. Once you have a
picture of the patients blood pressure throughout the day it is better possible to adjust the
patients medication rationally rather than based on a single reading in the clinic.