White Coat Hypertension

Years ago, many in the medical field did not believe that White Coat Hypertension was a correct explanation for elevated BP readings which "supposedly" occurred only in the doctor's office. This phenomenon is now a diagnosis that is taken seriously. Not only is White Coat Hypertension a recognized form of high blood pressure, it is now seen as a likely precursor to developing sustained hypertension. It is usually viewed as a significant risk factor for the later development of high blood pressure, and can be weighed with other risk factors such as being overweight, family history, and lack of exercise.

Many doctors now recommend that a patient use a home blood pressure monitor to keep a record of BP readings for several days, measuring it at set periods under similar conditions so that the results can be averaged to give meaningful information. This can be compared to office readings to aid in developing the right treatment plan.

If you want to monitor your own blood pressure at home to compare with your doctor's office readings, you should measure it at least twice a day. Mornings, 1/2 hour after arising, and evenings, 1/2 hour before retiring, are commonly recommended. Some doctors recommend measuring at additional times throughout the day. Here are some tips to help you get consistent, reliable readings at home.

• Exercise is good for you, but it will cause a natural surge in your blood pressure. Always wait 30 minutes or more after exercising to check your BP.

• Caffeine, tobacco, and medicines (including OTC meds for allergy or sinus relief, decongestants, cough meds and others) are known to raise BP. Wait until after you do your BP reading to take them, and let your doctor know that they may be in your system.

• Sit quietly and comfortably for 5 - 10 minutes before you take the reading. Have both feet on the floor, uncrossed feet and legs, and avoid tense postures like folded arms. Try to use the time for relaxation, prayer or meditation, or listen to pleasant music. Don't watch an intense or aggravating television show and then expect your blood pressure and heart rate to be normal.

• Take your blood pressure equipment to your doctor's office and calibrate it. This is a good way to make sure it is working properly and that you know how to use it correctly. You need to know that a 140 on the doctor's equipment reads at 140 on yours. Make sure the batteries are good. Inspect the cuff and tubes to be sure there are no leaks.

In understanding White Coat Hypertension, it is important to remember that the BP really is elevated in the clinical setting, which is a normal reaction to stress and anxiety for many people. Even if their BP is usually lower and within normal ranges, the fact that stressful situations can cause these spikes needs to be addressed. You can work on ways to handle stress such as meditation, self hypnosis, and other relaxation and calming techniques. Lifestyle changes can make a big difference in how you handle stress and in how your body responds to it. The universally touted health benefits of good diet, plenty of exercise, and plenty of rest will go a long way in keeping your stress level and your anxiety reactions under control.

Medication is sometimes prescribed, especially for those who live a high-stress lifestyle who can't or won't change. One issue with the medication treatment option is that during periods of "normal" BP, the medication may actually cause BP to be too low. Discuss the many treatment options with your doctor, and always keep your follow-up appointments, even if you are feeling great. If you are successful in making changes such as exercise habits and weight loss, your need for medication may diminish. These lifestyle changes don't happen overnight, and it's great to have a track record of what has worked for you.

Sources:
Family experience, 30+ years
GP's advice and options