6 Tips to Prevent “White Coat Hypertension”

in collaboration with

Dr Gérald Kierzek (Medical Director)

In France, one in two hypertensive people does not know it. Hence the importance of having your blood pressure checked regularly by your doctor to detect hypertension early. But for some people, it is the consultation itself that causes anxiety and higher tension than usual. This is called “white coat syndrome,” or “white coat hypertension.”

Where does this white coat hypertension come from?

By definition, we therefore call hypertension a blood pressure in consultation which is equal to or greater than 140/90 mmHg. But white coat hypertension, that is to say linked to the context, concerns up to 20% of patients. Why that ? Doctors who are familiar with the phenomenon have looked into the question.

According to the Ochsner Health Network in the USA, the reasons for white coat hypertension can be both mental and physical:

• “Your body may perceive walking into the exam room, having your blood pressure checked, or the fear of being diagnosed with hypertension as stressful events. The endocrine and sympathetic nervous systems then contribute to a “fight or flight” response as they would in a dangerous situation.”
• Others may create more of a “self-fulfilling prophecy”: they experience stress related to the doctor’s office or past experiences they may have had there.
• Finally, expecting their blood pressure to be high can create anxiety in itself. Over time, their minds and bodies become conditioned to create high blood pressure in this context

White Coat Hypertension May Lead to Unnecessary Prescriptions

However, this apparent hypertension should not be taken lightly. People who experience this syndrome must benefit from annual blood pressure monitoring as well as the implementation of health and diet measures, because the risk of transitioning to permanent hypertension is high. The other risk, however, is to misinterpret this tension and prescribe unnecessary medications. A risk also mentioned by Health Insurance:

“The hypertension white coat is responsible for approximately a third of hypertension diagnoses and the origin of drug treatments in non-hypertensive patients (patients more at risk of developing permanent hypertension during follow-up, but not more at risk of develop a complication of hypertension, therefore monitoring required without treatment) but also excess treatment in known hypertensives.

5 tips to avoid the phenomenon

To counter this phenomenon, the Ochsner health network has shared 5 strategies to be as close as possible to your usual tension at the doctor’s office.

• Be your own advocate. This means finding a healthcare professional with whom communication is easy and open. A better healthcare professional/patient relationship can reduce anxiety;
• Prepare. Avoid activities that may temporarily increase your blood pressure, such as caffeine, exercise, and smoking right before your visit;
• Practice relaxation. Try deep breathing or meditation while waiting for and during the blood pressure measurement;
• Find a distraction. Bring reading materials or find posters in the office to read during the measurement. Ask the doctor or nurse to speak gently to help you take your mind off the test;
• Stay informed. Ask your doctor about your routine checkup and find out about the condition you need help with.

Take your blood pressure at home, instructions for use

Finally, according to Dr. Gérald Kierzek, an emergency physician and medical director of Doctissimo, the safest way to monitor your blood pressure without suffering the white coat effect is to do so.n outside the medical office, at the patient’s home in order to confirm the diagnosis of hypertension, by self-measurement of blood pressure (AMT) or by ambulatory measurement of BP (MAPA).”

To do this, certain rules must be followed:

• Use a validated device and preferably with a humeral cuff;
• Be trained in the technique of self-measurement of blood pressure (and if necessary train those around you);
• Take measurements in a seated position, at rest with your forearm resting on the table
• Take 3 measurements in the morning before breakfast and taking medication, 3 measurements before bedtime, 3 days in a row (“rule of 3”), spacing the measurements a few minutes apart;
• Write down the BP values ​​(systolic and diastolic) that you will take back to your doctor.