Johns Hopkins Health Alerts | Hypertension & Stroke | Treatment Options for White Coat Hypertension

• As many as 20% to 35% of people diagnosed with white coat hypertension have what appear to be normal blood pressure readings at home.

Does going to a doctor’s office cause you enough stress to raise your blood pressure? If so, you’re not alone. Most people with hypertension (high blood pressure) have higher readings when a doctor takes their blood pressure than when they take it themselves. In fact, as many as 20% to 35% of people diagnosed with hypertension have what appear to be normal blood pressure readings at home.

This phenomenon is known as white coat hypertension. Some, but not all, experts believe that white coat hypertension can lead to unnecessary use of medication.

If your blood pressure is greater than 140/90 mm Hg on two or more separate occasions in a doctor’s office, there are several ways to find out whether you have white coat hypertension:

• First, if your doctor usually measures your blood pressure, see whether it goes down when a nurse measures it—some people experience white coat hypertension only with a physician.

• Second, you could get a home monitor and measure your own blood pressure twice a day for a week.

• Finally, if your average home blood pressure reading is below 135/85 mm Hg, ask your doctor whether you’re a candidate for ambulatory blood pressure monitoring, in which blood pressure is repeatedly measured over a 24- to 48-hour period. An average ambulatory blood pressure reading below 130/80 mm Hg despite elevated office readings is termed white coat hypertension.

Whether to treat white coat hypertension with antihypertensive medication is controversial. Several studies have suggested that people with white coat hypertension are at higher risk for heart attack and stroke than people with normal blood pressure and should be treated. Other studies have found that people with white coat hypertension are not at increased risk.

Until a definitive answer is reached, you should follow your doctor’s advice on taking blood pressure medication. If you have no other risk factors for cardiovascular disease (such as diabetes or being a smoker) or damage to organs such as the heart, brain, or kidneys, ask your doctor whether it would be safe for you to be monitored without medication.

People with white coat hypertension, like other adults, should follow a healthy lifestyle to reduce the likelihood of heart attack and stroke. In addition, they should have repeat ambulatory blood pressure monitoring every one or two years if they are not taking medication.

Johns Hopkins Health Alerts | Hypertension & Stroke | Treatment Options for White Coat Hypertension