Is ‘white coat syndrome’ why my blood pressure goes up at the doctor’s office?

If you’ve ever received a concerned reaction from a doctor when they take your blood pressure, even if it’s generally normal, you’re not alone.

For many patients, a medical setting can create anxiety. This can cause your blood pressure to spike, even if you’re unaware of it — a condition commonly referred to as “white coat hypertension” or “white coat syndrome.”

Blood pressure readings consist of two numbers. The first, known as systolic blood pressure, measures the pressure in your arteries while the heart beats. Diastolic blood pressure denotes how much pressure is in your arteries when the heart is between beats. A healthy number is 120/80.

Among patients who have blood pressure higher than that in a medical setting, up to 30% are because of white coat syndrome. But just because it’s common doesn’t mean it should be ignored or that it’s not a sign of a potential health concern.

Here some answers to common questions about white coat hypertension:

What are some of the main causes of white coat syndrome?

Most often, it’s because patients feel anxiety about their own health or being diagnosed with something. It can also be as simple as feeling rushed. Hurrying to get to the appointment or while being brought back to the room can cause a temporary increase in blood pressure.

What steps do you commonly take to determine if the high blood pressure reading is temporary?

If a patient’s blood pressure is high in the clinic, we’ll advise them to start taking their own blood pressure at home. In certain cases, we can give them a cuff to wear that automatically takes their blood pressure at certain intervals over a 24-hour period and assess those numbers.

This approach is used if a patient’s systolic blood pressure is between 130 and 140 or diastolic blood pressure is between 85-90 during at least two office visits. If the systolic is above 140 and/or the diastolic is above 90 in multiple office visits, we generally diagnose that patient with hypertension.

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If it’s determined that someone has white coat syndrome, what do you advise?

Since these individuals are still at intermediate cardiovascular risk, we recommend that these patients follow lifestyle modifications, such as weight loss, dietary changes and exercise. We also continue to monitor these patients for development of sustained high blood pressure more frequently (once a year, at least).

Can "white coat syndrome" have symptoms other than higher blood pressure?

Generally, there are no symptoms associated with white coat hypertension. However, if the elevated blood pressure is associated with anxiety, the patient could be experiencing other symptoms, such as racing heart or palpitations.

If my blood pressure spikes at the doctor's office, could it be spiking elsewhere, too? Is that bad for my health?

It’s reasonable to assume that blood pressure spikes may be occurring at other times of stress, which is why it’s important to get blood pressure readings in different settings. If a patient is experiencing consistent anxiety or stress at home, too, then the blood pressure readings at home may reflect this.

Having sustained or intermittent high blood pressures still puts patients at intermediate cardiovascular risk. This is why it's recommended that these individuals follow lifestyle modifications, including stress reduction.