Introducing white coat hypertension

Some patients visit my office with their blood pressure being abnormally high and can be over 130/90 at times. This is what we call the ‘white coat hypertension’. Even though it is highly believed to be caused by the anxiety of seeing the doctor, it is also evident that patients who are long established and don’t have any conscious anxiety are known to exhibit high blood pressure while in the office. Considering the natural fluctuation of blood pressure and the fact that office visits aren’t ‘normal’ settings as such, it is crucial that patients with high blood pressure or hypertension have a BP cuff which they can use at home.

Nowadays, such devices are highly automated which makes them easy to use and everyone with hypertension is recommended to have their BP closely monitored while at home. You are advised to take multiple readings of your blood pressure over a week during different times of the day. Make sure that you take your readings while resting and also as you rush around. Also, take your blood pressure after a meal and after exercising. It is essential that you write it down in a log. This will enable you to see the patterns of your blood pressure and know whether or not it is controlled.

Blood pressure reading at the doctor’s office

Unknowingly to most people, readings of blood pressure at the doctor’s office aren’t the most accurate. In most cases, patients are rushed around so that they can be in the office on time. At other times, medical assistances tend to use wrong sized cuffs and the arm is not positioned correctly. There are errors involved with listening or auscultation which makes it less accurate. Multiple readings over a prolonged period of time are the only way you can control your blood pressure accurately.

Recording a high blood pressure at the office could mean one of two things. First, this could be true hypertension/ high blood pressure or could also be the ‘white coat hypertension’ which can be controlled at home. In case a patient is currently taking medication for blood pressure and his or her BP at home is controlled, more medication shouldn’t be added just because their blood pressure at the office is elevated. For a patient who is yet to be diagnosed and deemed to be suffering from hypertension and their blood pressure at the office is elevated, such a patient is advised to acquire a home cuff to take their BP readings at the comfort of their home and return them to the doctor for analysis and review. This can help in minimizing expensive and unnecessary medications while ensuring that the patient is also adequately protected at the same time.