White Lab Coat Syndrome

White lab coat syndrome, or white coat hypertension, is a phenomena where a person's blood pressure reads at 140/90 or above, in a medical setting but is normal in other instances. The term refers to the white coats that doctors wear. White coat syndrome is not actual hypertension and clears up when the patient leaves the medical setting. Because patients with white coat syndrome have consistently high readings, doctors may incorrectly diagnose the condition as actual hypertension and prescribe medication. This is a problem because in people with normal blood pressure, anti hypertensive drugs can cause a dangerous drop in blood pressure.

Causes

• The exact causes of white coat syndrome are not clear, but it is speculated that negative feelings about the clinical experience trigger the fight-or-flight response, causing an artificial elevation in blood pressure. Some people may not be aware of their level of anxiety and may even think they are relaxed. Others can have no previous history of white coat syndrome, then have a negative clinical experience that results in high readings from that point on.

Diagnosis

• The best way to diagnose white coat hypertension is to take consistent blood pressure readings outside of a clinical setting. Patients can take daily readings at home, with an electronic monitor or they can wear an ambulatory blood pressure monitor (ABPM). With an electronic monitor, patients are advised to take several readings, at certain times of day, over a two-week period and record the results. The doctor then takes the readings and calculates an average. With an ABPM, the patient wears a small portable device that records blood pressure over a 24-hour period then calculates the average. An average reading at or below 135/85 is considered normal.

Treatment

• Currently, there is no known treatment for white coat syndrome but relaxation techniques and meditation may help patients achieve lower readings in the doctor's office. Patients can also monitor their own blood pressure on a monitor that's calibrated to the monitor in their doctor's office. Taking their own readings allows patients to keep track of blood pressure while providing medical professionals with a more accurate picture of their blood pressure status.

Risks

• Doctors believe that people with white coat hypertension are less at risk for heart disease than those with sustained hypertension but at more risk than those with consistently normal blood pressure. People with white coat hypertension also tend to develop sustained hypertension later in life. It's important for people with white coat hypertension to consistently monitor their blood pressure to be alert to any possible increases over time.

Conclusion

• Consistently high blood pressure readings may indicate hypertension or may indicate a reaction to the clinical setting. Hypertension is usually diagnosed over time, not just with one reading (or group of readings). Patients with consistently high clinical readings should consult with their doctors and consider supervised self monitoring to determine which type of hypertension they have.