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White Coat Hypertension

What is white coat hypertension?

Also called white coat syndrome, it refers to when a person has a higher blood pressure reading when in a hospital compared to at home


It is called white coat hypertension as health care professionals who measure the patient’s blood pressure sometimes wear a white coat!


A healthy blood pressure reading is around 120/80 mm Hg, readings higher than this are considered high blood pressure


[** Did you know: 120 is systolic blood pressure (the pressure in your arteries when your heart beats) and 80 is diastolic blood pressure (the pressure when the heart ‘rests’ between the beats)]


Around one in five people experience this, and it can be acute or chronic


Around 15-30% of high blood pressure in the doctors' office are actually caused by white coat hypertension


Many people (especially elderlies) ‘freak out’ when they see their blood pressure being higher than normal and it rises even more when healthcare professionals take their blood pressure…Why is this?


What is hypertension?

  • It is a medical term to express high blood pressure

  • Normal human beings would have different blood pressure levels throughout the day and night based on activities and other factors, no matter their age.

  • Higher blood pressure levels may increase the risk of having other health problems, such as heart disease, heart attack and stroke

HOWEVER…

  • NOT ALL high blood pressure will lead to these severe diseases and conditions.

  • For example: if we took the blood pressure of a teenager who is playing basketball under the blazing sun, their blood pressure would be very high, but that doesn’t necessarily mean they will get heart disease or have a heart attack.

  • Blood pressure is a natural and essential part of body functioning, e.g. fight or flight response, when under tense situations, sports and is needed to deliver and remove oxygen and waste products of cells.

  • Therefore, getting a slightly higher blood pressure isn’t always a bad thing


What are the causes of white coat hypertension?


Anxiety & Stress

  • Being nervous and anxious when a medic takes a reading of the patient's blood pressure

  • This may also include health anxiety

  • Elderly patients often feel stressed by as they lack knowledge of what is considered sickness and what is normal

  • Those who have been diagnosed with generalised anxiety are believed to have more chances of white coat hypertension

Stress Hormones

  • Anxiety and stress are the results of the release of stress hormones such as cortisol and ACTH

  • Some people with insomnia may find high blood pressure as lack of sleep may lead to a reduction in the body’s ability to absorb cortisol, leading to more stress

Phobia

  • Patients may have the fear of taking blood pressure

  • However, this would mean taking blood pressure at home or in normal settings will also give high blood pressure


How to overcome white coat hypertension


As a doctor…

  • They will do a full body check-up and refer to past medications or illnesses to see if it is a concern or a signal of a long-term health condition

  • They will help patients relax, such as by removing the attention on blood pressure at first and returning to it once the patient feels more comfortable

  • If the patient still feels anxious and if they went to the hospital just because their blood pressure is high, or if they are feeling sick because of high blood pressure, doctors may use a placebo to calm the patient to enable clear diagnosis.

  • Doctors will also check ‘blood pressure journals’ that the patient notes at home, which shows longitudinal data for doctors to reference - doctors will try to spot trends and hence make a judgement

As a patient…

  • Practising breathing relaxation techniques, such as the 4-7-8 breathing rhythm (breathing 4 seconds, holding for 7 seconds and exhaling for 8 seconds)

  • Drink a glass of water - not only does it help hydrate the brain, it also helps excrete some of the excess sodium which could have caused the high blood pressure in blood

  • Go for a walk

  • Understand the concept of blood pressure and don’t be too overwhelmed by a sudden increase in blood pressure


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