Just a minute ago, I got a call from one of our clinics with a problem. They said that the man that they were testing had a high heart rate, but it was because he has “White Coat Syndrome”. Now, I’d never heard of it, but the nurses knew what it was. Since I got the chance to learn something today, I decided to share with everyone.

What is white coat syndrome?

White coat syndrome is a situation where patients have high blood pressure in the doctor's office but nowhere else. The situation is generally not this clear-cut, however, and often the patient has occasional episodes where the blood pressure is high when taken at home, but it is reliably high when taken in the physician's office. Some patients with sustained high blood pressure will have higher readings in the doctor's office than at home. It is really not very uncommon. The patient generally

does not feel the slightest bit of apprehension when coming to the doctor, or even in the office when the blood pressure is high. The mechanism appears to occur at a subconscious level.

If blood pressure is just very occasionally high, it is not as dangerous as when it remains elevated most of the time. If in fact the blood pressure is noted to be high almost exclusively in the doctor’s office, many physicians will not prescribe any treatment at all. Some studies have suggested however that white coat hypertension may "turn into" sustained high blood pressure. This really makes more sense to me since the same types of stresses occur in everyday life.

There are two main problems or dangers with this condition:

The first is the tendency for some patients to put themselves in this category, saying to themselves "it's only high at the doctor's office . . . I don't need any treatment".

The other danger is that the high reading taken in the doctor's office is assumed to be the patient’s usual blood pressure, and he or she is overtreated.

The most prudent course seems to be:

Monitor patients with white coat syndrome closely. Obtain a blood pressure cuff and have your blood pressure taken on multiple occasions. Write the readings down and bring them to your physician.

There are devices which can be worn for 24 hours to measure the blood pressure throughout the day. These may be useful in providing a clearer picture of how long and under what circumstances a person's blood pressure may be elevated.

Continue to follow the general rules noted above: strive to maintain ideal body weight, avoid overuse of salt and sodium, and follow an exercise program.