When you have normal blood pressure readings at home but high in a doctor’s office, it is called white coat hypertension or white coat syndrome, which it is not a benign condition, according to new research.
Patients with white coat syndrome, who do not take antihypertensive agents, are twice as likely to die from heart disease when compared with patients who have normal readings, according to a meta-analysis study published Monday in the Annals of Internal Medicine.
It is unclear what exactly causes white coat hypertension, as it may have different triggering factors in different patients. For some patients, anxiety might be the cause in a medical setting, while others may have fluctuating blood pressure because of some underlying physiological condition.
The research suggests that at least 1 in 5 American adults may have white coat hypertension.
The researchers at Penn Medicine, a world-renowned academic medical center in Philadelphia, reviewed 27 studies that involved over 64,000 patients in the United States, Europe, and Asia.
When they compared people with normal blood pressure readings both at a doctor’s office and home, patients with white coat hypertension were found to be at risk of having cardiovascular events and even death.
The study found that patients with untreated white coat syndrome had about 36% increased risk of heart disease, 33% increased risk of death, and 109% increased risk of death from heart disease.
The study co-author Dr. Jordana Cohen said, “This finding was most robust in studies where participants were 55 years old or older on average and studies that included patients with previous cardiovascular disease.”
The researchers noticed that one separate group of patients who had variable blood pressure readings did not face an elevated risk of heart disease, who belonged to the group of the “white coat syndrome.” These patients had blood pressure readings high in the doctor’s offices but normal at home, and are already taking antihypertensive drugs. They had no increased risk of cardiovascular events or death, according to their analysis.
The researchers concluded, “Although more research is needed, we encourage lifestyle modifications (including improved diet, exercise, weight loss, reduction in alcohol use, and smoking cessation) in all patients found to have white coat hypertension.”
Dr. Daichi Shimbo, a cardiologist and an associate professor of medicine at Columbia University Medical Center, said, “Recent guidelines in both the United States and Europe recommend blood pressure monitoring to screen for white coat hypertension and white coat effect. He also emphasized the importance of considering home readings to diagnose high blood pressure.
Home blood pressure monitoring, which included self-measurement of blood pressure, is done with a store-bought device that is not fully automatic and is more practical and worthwhile. Dr. Shimbo added that patients must get a decent device that is accurate. The American Heart Association (AHA) recommends getting an automatic, cuff-style, bicep monitor that has been validated. You can ask your pharmacist about how to use it appropriately for self-monitoring.