Skip to main content

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.
Labels:

Popular posts from this blog

Multivitamins

If you can get the lid off, you probably don't need them When I ask people if they are taking any vitamins, herbs or supplements, many people will say they are taking a multivitamin.  When I ask them why they take it, I get a quizzical look most of the time. I think this is something that resonates from childhood and parental advice of the idea that we need vitamins to help our body develop.  I'm not pediatrician so I can't speak to the effects on the developing child, but I will say that most non-pregnant adults without major medical conditions do not need extra vitamins. You'll be impressed by these labels promising 120%, 300%, 1200% of your daily dose of vitamin whatever it is, but the truth is that for most of these vitamins, if you take more than your daily dose your body needs, the rest just ends up in your urine.  You are literally peeing money away in this case. There's been a new trendy vitamin every decade or so for the last 40-50 years; First it...
Read more

Kidney Stones

I've written about this previously , but it's often hard to explain to people what a 10 is on the "1-10" pain scale if they haven't been in that spot before.  For women who have had children, they generally know what a 10 is, but for men it's a little harder.  When I was a medical student on my psychiatry rotation, we had a patient calmly sitting there saying his pain level was at a 10 and our resident, who was an ex-military sniper with a large skull tattoo on his forearm and a crosshair through the eye, calmly leaned forward and asked, "so if I lit you on fire and ran you over with my truck, you could not be in more pain than you are now, correct?"  The patient changed his answer. Getting to the point, a kidney stone is about the close I can come to describing a 10/10 pain to people who haven't gone through childbirth.  The fundamental issue is similar - your body is trying to move a big solid thing through an opening that was not really desig...
Read more

NSAIDs

Advil and Motrin are ibuprofen, then you have Aleve (naproxen).  Those are the over-the-counter ones.  Prescriptions are Mobic (meloxicam), nabumetone, indomethacin, Toradol (ketorolac), diclofenac, Lodine, and the list goes on.  All of these medications are in a class called non-steroidal anti-inflammatory drugs (NSAIDs). I'm giving you this list because there is mounting evidence that these medications a) don't work as well as we'd thought and b) have some very serious long term side effects we're finding out more about. NSAID's act by reducing the amount of prostaglandins you make in order to reduce inflammation.  However, prostaglandins have a ton of other effects and are involved in the maintenance of just about AIDs and also stronger if they are taken every day and/or around-the-clock.  every other organ system that you have.  The effect is stronger with higher doses of NS NSAID's work best and are best indicated for times when something is r...
Read more