Is White-Coat Syndrome Real?

By: Sarah Galzerano, Integrative Marketing Specialist, Jefferson Health – NJ

Have you ever noticed that your blood pressure runs abnormally high when you’re at your healthcare provider’s office? If so, you’re not alone.

Heightened stress levels are incredibly common in any healthcare environment; they contribute to a phenomenon known as “white-coat syndrome” (or white-coat hypertension), which derives from the traditional white coat worn by a practicing physician.

Studies show that nearly 1 in 5 people experience white-coat syndrome. While it usually isn’t a cause for concern or treatment, it can be confused with actual, chronic hypertension, if not careful.

Molly Hammond, APN, of Woodbury Primary & Specialty Care, Jefferson Health – New Jersey. Photo credit: Jefferson Health – New Jersey

We spoke with Molly Hammond, APN, of Woodbury Primary & Specialty Care, Jefferson Health – New Jersey, to learn why white-coat syndrome occurs; how providers typically diagnose it; and what everyone can do to stay on top of their blood pressure.

Everyone can have a different underlying cause, explains Hammond. “It may be related to health anxiety, or the fear that you’re going to find out something is wrong with you; the fear of having an elevated blood pressure reading; or an actual traumatic experience that you’ve had in a healthcare setting.”

Why does stress cause our blood pressure to rise? When our body perceives an uncomfortable or threatening situation, it releases a flood of stress hormones, causing your heart to beat faster and your blood vessels to narrow, thus causing a rise in blood pressure, says Hammond.

A spike can be as short-lived as a few minutes. So, when providers see a high blood pressure reading in an individual who doesn’t have any prominent risk factors for – or a history of – hypertension, they do a “re-do” at the end of the visit, adds Hammond. “Nine times out of 10, by the time the patient has calmed down, their blood pressure is back to normal.”

A patient presenting with white-coat syndrome should always be assessed for common symptoms that accompany hypertension, such as severe headaches; fatigue; vision problems; chest pain; or difficulty breathing. If none of these are expressed, at-home monitoring of blood pressure is recommended.

On the other hand, some people experience what is known as masked-hypertension – a normal or low reading in office, with an elevated reading at home – though this is much rarer.

“The natural waves of blood pressure are complex, and we don’t always know what causes a spike or a dip,” says Hammond. “However, low dips raise a red flag, moreso than spikes. Hypotension, whether temporary or chronic, can be a sign of dehydration, low blood sugar, or a serious infection, and it needs to be treated.”

Because blood pressure complications become more prevalent with age, many adults over the age of 40 are advised to monitor their blood pressure at home to some extent. Depending on your provider’s recommendations, you may have to take it on a weekly or twice-daily basis (once in the morning and once in the evening).

There are factors and behaviors that can skew a blood pressure reading, notes Hammond. It’s best to avoid alcohol, caffeine, and tobacco before taking your blood pressure. It’s also important to make sure your cuff is placed properly, your legs aren’t crossed, you’re sitting still, and you don’t have a full bladder.

Your primary care provider may prescribe a specific blood pressure cuff. If you end up buying one on your own, you can always bring it into the office to have it demonstrated, adds Hammond.

White-coat syndrome has been found to be more common in women, older adults, overweight adults, and non-smokers. However, more often than not, white-coat syndrome is a manifestation of chronic stress and anxiety.

Because chronic stress and anxiety can lead to chronic hypertension – among many other negative impacts – it’s key to find ways to cope and manage it as best as possible.

“Try to incorporate more self-care and personal, reflective time into your daily schedule,” continued Hammond. “It’s also important to stay physically active; maintain a healthy sleep schedule; dedicate time to hobbies and social interaction; and seek professional help, when needed.”

When you successfully reduce stress in your overall life, it is likely to help reduce occurrences of white-coat syndrome as well.

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