What is white coat syndrome?

According to a study from the journal of Psychology Research and Behavior Management, white coat syndrome is when a patient exhibits high blood pressure while at the doctor’s office but has a normal blood pressure range outside of the doctor’s.

Hence, the name “white coat syndrome” is associated with people who have medical apprehension around the presence of a physician, creating a rise in blood pressure.

Taking your blood pressure at the doctor’s office can make some people nervous. A sterile patient room, stiff examination table and a squeezing device pressing against your arm are just a few triggers that spark nerves. But have you heard of white coat hypertension, commonly known as white coat syndrome?

Each person’s blood pressure range is individual, but there’s a specific range your numbers should fall in between to be considered healthy. A normal range should have a systolic number of at least 120 over 80, while 140 or higher over 90 is considered high blood pressure, or hypertension, according to the American Heart Association.

Dr. Christopher Hughes, a family medicine physician at Advocate Eureka Hospital in Eureka, Ill., affirms white coat syndrome and white coat hypertension are real; he sees them in the office regularly.

Why does white coat syndrome occur?

A multitude of factors play a role in this syndrome. And sometimes it can even lead to a misdiagnosis, according to the study researchers. They mention gender is not the root of the cause, but women who often feel stressed are more at risk. Thus, visiting the doctor can cause extra anxiety, and when a physician walks into the room, blood pressure quickly spikes. Other factors include people who predict they will have a high blood pressure reading or feel nervous about the physician.

In order to determine any discrepancies between white coat syndrome and an accurate blood pressure reading, Dr. Hughes recommends doing a bit of homework before coming to your appointment.

“I generally recommend patients purchase an over-the-counter arm blood pressure cuff and take their own measurements at home. Proper blood pressure needs to be done with the patient sitting and at rest for at least five minutes,” he says.

Another method is taking your blood pressure periodically outside the doctor’s office and coming in for a nurse blood pressure check. Dr. Hughes advises to bring in your home cuff and numbers during these nurse visits. If the number remains high outside the office, and the cuff confirms it, then further treatment and workup would be discussed.

“Any systolic blood pressure above 140 or diastolics above 90 would be concerning in most adults, although elderly patients can let their systolic or top numbers run slightly higher,” he says.

One more reminder? The study researchers encourage building stronger verbal and nonverbal communication during visits to help reduce apprehension, especially for taking blood pressure readings. Positive communication involves asking open-ended questions, making eye contact, practicing active listening and having a sense of personal understanding between both patients and medical staff.