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White Coat Syndrome / White Coat Hypertension

You can't sugar coat it with a White Coat

In more semi-breaking news, there has been a lot of talk about blood pressure recently, with new guidelines coming out in the last year as well as a lot of new information about what is considered to be high blood pressure.

Many people will say that their blood pressure taken at the doctor's office is "always high" because of a number of factors–it could be the anxiety that comes with being in the doctor's office or seeing some people in a white coat or the hassle of getting to the doctor's office and finding parking, or even realizing that you had forgotten to bring your favorite doctor the homemade cookies or funny hat that you had gotten for him.  Or her.

But a recent study gave some information about what it actually means for your long-term survival depending on what your blood pressure is in the office and out in the real world.

They checked their blood pressure in the doctor's office and also had them wear a 24 hour blood pressure monitoring device that showed people were in one of these groups

- Normal blood pressure or blood pressure controlled on medications
- "White Coat" hypertension, where your blood pressure is only elevated at the doctors office
- "Masked" hypertension, where your blood pressure is high everywhere except the doctors office
- Persistent hypertension, where your blood pressure is high everywhere, even if you're on medications

There were a few very interesting things here

- The systolic (top) number seems to be far more important than the diastolic in terms of your risk of dying.

- If your blood pressure is normal at baseline, controlled on medications, or you have white coat hypertension but you are also on medications, you are OK.  For everyone else, your risk of death goes up.

- If you have white coat hypertension and you're not on medications, it's taking 4-14 years off your life.  This is probably because your blood pressure is not just high at the doctor's office, but also in other stressful situations

- If you have sustained hypertension, it can take 6-20 years off your life.  The worst is masked hypertension where you're talking 15-30 years off your life, though this type if much less common, but obviously concerning if the place you are most relaxed is at the doctor's office.

One limiting factor for this study is that it used 24 hour blood pressure monitoring, where you're wearing a cuff that's checking your blood pressure every 20 minutes for a full 24 hours.  This can be useful sometimes but isn't too commonly done, however that may be changing based on some of this new research.

To me, I think the main point I see is that we can't just blow off a high blood pressure at the doctor's office as being harmless anymore and I think if it is consistently high in my office, we should have people be checking it throughout the day in various situations in their daily life to see what it is because it's a chance to make a significant impact on what you spend your retirement doing.
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