White Coat Hypertension 

Over our years of practice, one of the most common scenarios we run across is something called “white coat hypertension”. This is a term used in the medical field to describe patients whose blood pressure rises significantly when they are in medical offices or in medical settings. 

We often joked with patients that simply walking through the door of the exam room is enough to raise their blood pressure by at least 10 points (if not more). Appointments can be stressful for people, and we get it! So, we hope to give some helpful advice if you experience this and give some pointers on how to prepare for your next appointment. 

White coat hypertension is actually quite common, and the Cleveland Clinic estimates up to 30% of patients experience it at some point. It can prove to be a bit tricky for a medical provider however, because elevated blood pressure can be dangerous if left untreated. That blood pressure of 158/94 doesn’t look so good, but deep down you know how anxious you feel, and you are certain your blood pressure is elevated because of this. Your provider might feel the same way, and they don’t want to jump into starting any medications based on one blood pressure reading. 

They will probably start by rechecking your blood pressure, which may or may not be helpful, as by this time you are already over-thinking things and as soon as that cuff goes on you can practically feel your heart rate and blood pressure rising again! This might be followed by “Did you have caffeine today?”, or “Have you ever had high blood pressure before?” 

Taking Control: What You Can Do 

Sound familiar? Here’s what you can do to help. 

How to Prepare for Your Next Appointment 

If you think (or know) you have white coat hypertension, it will be well worth your time to purchase a blood pressure cuff and measure your blood pressure 1-2 times daily in the week or two weeks leading up to your appointment. Here are a few things to keep in mind. 

Tips for Checking Your Blood Pressure at Home 

1. Buy an upper arm cuff instead of a wrist cuff. 

2. Upper arm cuffs tend to be more accurate. Please be aware there are some situations in which upper arm cuffs should not be used (lymphedema, AV fistulas etc). 

3. Make sure the cuff you purchase is good quality. Click here to view a list of blood pressure monitors that have been validated and tested for accuracy by the American Medical Association. 

4. Check your blood pressure at a consistent time. 

5. Most people check their blood pressure right when they get up for the day, which is great! Use the same arm each time for consistency and make sure you are sitting with your feet flat on the floor with the cuff at about heart level. 

6. Keep track! 

7. Many monitors have a built-in memory but write them down just in case so your results can be easily viewed. Make sure you show your provider your results. 

Please note: If your blood pressure is consistently elevated at home and in the office, it is best to listen to the recommendations of your medical provider as you may have hypertension. 

Pro Tip: Bring Your Blood Pressure Monitor to Your Appointment 

By doing this, you can verify the accuracy of your monitor against the monitor used in the office. If you can show you have normal blood pressure at home, and your home monitor matches the one the office uses, you offer a far more convincing case that you have white coat hypertension. 

If you have white coat hypertension, these steps could possibly save you from having to schedule a follow-up appointment and help alleviate some stress. Not only that, but we are sure your doctor will appreciate the initiative you took to be a partner in your own health care. 

If you do not check your blood pressure at home and your blood pressure is elevated in the office, your doctor will very likely want you to buy a monitor and begin checking it. He or she will then want to see you for a follow up to review your results. Some providers may even want to prescribe a new medication to you, depending on how elevated your blood pressure reading is.