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Can White Coat Hypertension Kill You?

Doctor in white coat with stethoscope

White coat hypertension may more than double your risk of a heart attack. About 1 in 5 American adults have white coat hypertension (high blood pressure in the doctor’s office but not at home) In a recent review researchers analyzed  27 studies involving more than 64,000 patients in the United States, Europe and Asia. Findings revealed that compared with people with normal blood pressure readings (both at home and at the doctor’s office), patients with white coat hypertension were at elevated risk for heart attack and death.

White Coat Hypertension Might be Happening Outside the Doctor’s Office

The data showed that those patients with untreated white coat hypertension had a 36% increased risk of getting heart disease, 33% increased risk of death due to any cause and 109% increased risk of death from heart disease. This study did not find a strong association with stroke but other studies did. I think it can increase risk. This finding was most significant for people 55 years or older.

White coat is caused by anxiety. With anxiety excitatory neurotransmitters such as epinephrine and nor-epinephrine increase. These are short acting stress neurohormones that cause constriction of the vessels, driving pressure up. When the stressor is gone levels typically return to normal. Very stressed out individuals will have higher levels for longer along with elevated cortisol as well. I do tests that measure stress hormones if needed.

I tell my patients “If your blood pressure is high here in my office its going to be high with any stressful situation.” White coat used to be dismissed and unimportant, but I never understood this. Now that ambulatory 24-hour blood pressure monitors are available its been more easy to see that pressure goes up with stress.

Knowing that your blood pressure might climb higher in your doctor’s office may actually become a self-fulfilling prophecy for some. In other words, the worry that you’ll have a high blood pressure reading may actually cause just enough anxiety to boost your blood pressure.

Action steps

If you’re feeling anxious or worried when you sit down to have your blood pressure measured, ask the doctor or nurse to wait a bit so you can calm down. Make sure you have been sitting for AT LEAST 5 minutes without talking. Do not cross your legs or talk during the measurement either. If you had to rush to the appointment take at least 10 minutes of quiet time first. You should these when you feel stressed any time of day.

  • Practice deep breathing
  • Try belly breathing, also known as abdominal or diaphragmatic breathing. Most of us take shallow breaths while holding the stomach in. Breathe so that you stomach feels filled with air. You are doing it right when it sticks out. Breathe in for a count of 6, hold for 6 and breathe out for 6. Do this for 2 minutes. Pressure should come down.
  • Measure your blood pressure at home. If you have hypertension at the doctor but not at home make sure you really have good data. Measure it once to twice a day at the same time. Try measurements when you feel calm as well as stressed and note it next to the measurement. Be aware that salty food will increase it.
  • Relax. Practice yoga and or meditation
  • Exercise. Get at least 200 minutes of aerobic exercise per week
  • Eat a heart healthy diet. Watch salt intake (2,000 mg a day)
  • Rest. Get at least 7-8 hours a sleep per night! I prefer 8.
  • Try supplements. There are many plant extracts, nutraceuticals, and other natural agents that can lower blood pressure that I can help you with.

In conclusion, white coat is a big risk factor. It needs to be addressed. If you can’t manage it let me help. There is even more that can be done if you work with me. Diet, lifestyle and stress management are all powerful tools.

Ann Intern Med. [Epub ahead of print 11 June 2019]. Cardiovascular Events and Mortality in White Coat Hypertension: A Systematic Review and Meta-analysis.

Ann Intern Med. 2015 Feb 3;162(3):192-204. Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the U.S. Preventive Services Task Force.