Table of ContentsView AllTable of ContentsMeaningDiagnostic DilemmaRisk FactorsManaging White Coat SyndromeManaging Blood Pressure
Table of ContentsView All
View All
Table of Contents
Meaning
Diagnostic Dilemma
Risk Factors
Managing White Coat Syndrome
Managing Blood Pressure
Many people experience stress and anxiety in healthcare settings, like hospitals or dental offices, which can lead to white coat syndrome. White coat syndrome is when blood pressure readings arehighin a healthcare setting but normal at home.This condition is tricky to assess and can lead to a false high blood pressure (hypertension) diagnosis.
This article discusses how to identify white coat syndrome and manage it at home or in healthcare settings.
Meaning of White Coat Syndrome
In some people, white coat syndrome eases with repeat appointments as comfort and familiarity with the healthcare provider and setting grow.
When Is Blood Pressure High?
Blood pressure is the amount of force that blood exerts on the walls of your blood vessels. This measurement is divided into two numbers:systolic and diastolicblood pressure.
Experts have established ranges for low, normal, andhigh blood pressure:
Having an elevated systolic blood pressure is a common sign of aging, so if you’re 65 or older, a healthcare provider may consider a blood pressure of 130/80 normal.In contrast, children and adolescents tend to have lower blood pressure.
Frequency of HBP Readings
If you have a high blood pressure reading in a healthcare setting, your provider will recommend you return for a second test to confirm your condition. If the second test also shows high blood pressure, your provider may recommend home or “ambulatory” monitoring.
During ambulatory blood pressure monitoring, you wear a blood pressure cuff for 24 hours. Over the 24-hour period, the cuff automatically measures your blood pressure every 15 to 30 minutes and records the data. Your provider reviews the data to identify any concerning patterns.
While home blood pressure devices don’t replace in-clinic testing, they can help healthcare providers detect blood pressure differences that may occur due to white coat syndrome. Providers look for significant differences between repeated at-home and in-clinic test results to confirm white coat syndrome.
If healthcare providers suspect you have chronic high blood pressure, they may recommend in-office and ambulatory blood pressure monitoring every three to six months.
Associated Symptoms
High blood pressure and white coat syndrome usually do not causesymptoms. However, in severe cases, symptoms indicative of the two conditions include:
White Coat Syndrome: A Diagnostic Dilemma
White coat syndrome is a significant challenge for healthcare providers. It can lead to false diagnoses, and the condition may carry its own risks. Furthermore, some people have masked hypertension, a “reverse” white coat syndrome in which blood pressure lowers to healthy levels when in clinical settings, also presenting a challenge.
How Common Is White Coat Syndrome?Though exact figures are unknown, studies suggest white coat syndrome is relatively common. Researchers found up to 30% of those with high blood pressure readings in clinical settings had normal results at home.
How Common Is White Coat Syndrome?
Though exact figures are unknown, studies suggest white coat syndrome is relatively common. Researchers found up to 30% of those with high blood pressure readings in clinical settings had normal results at home.
Unnecessary Prescriptions
The misleading readings due to white coat syndrome can lead to false or delayed diagnoses of high blood pressure. As a result, healthcare providers may start you on medications you don’t need or boost dosages when it isn’t necessary.
Unnecessary prescriptions can lead to side effects and negative health impacts. In addition, researchers found unnecessarily taking medications for high blood pressure lowered adherence to necessary medications.
Cardiovascular Risks
While white coat syndrome only causes temporary blood pressure spikes, it isn’t without cardiovascular risk. Researchers have found the following health risks associated with white coat syndrome:
Masked Hypertension
Masked hypertension is the inverse of white coat syndrome. It occurs when blood pressure readings in a clinical setting are within a healthy range when the patient actually has chronic high blood pressure. Masked hypertension can lead to delayed diagnosis or unnecessary changes in prescriptions. Untreated high blood pressure raises the risk of cardiovascular diseases, and masked hypertension is associated with organ damage.
Why Some People Experience White Coat Syndrome
Researchers believe white coat syndrome is a stress response to the hospital or clinical environment. It stimulates the sympathetic nervous system, triggering the fight-or-flight response, which releases adrenaline and other hormones and raises blood pressure.
Psychological factors also seem to play a role. In one study, researchers found that fear and anxiety about a healthcare provider detecting high blood pressure could even trigger white coat syndrome.
While everyone may be susceptible to white coat syndrome, certain populations are more likely to develop this condition. It occurs more often among women and people older than 50 (with increased prevalence with age).
How to Minimize White Coat Syndrome
The primary goal in alleviating white coat syndrome is to manage your body’s stress response. Blood pressure medications aren’t appropriate for this condition. Luckily, there are things you can do to address this condition at home and in your healthcare provider’s office.
At Home
Ambulatory blood pressure monitoring at home helps detect and manage white coat syndrome. Despite some limitations compared to in-office tests, checking your blood pressure at home or in a comfortable environment helps reduce the stress and anxiety that trigger white coat syndrome.
Learn and develop practices that ease anxiety and stress before taking your blood pressure at home. Such practices may include regular meditation or mindfulness exercises, deep breathing, or simply unwinding.
At a Provider Visit
There also are methods and strategies you can try in a healthcare setting to ease white coat syndrome, including:
Managing Chronic High Blood Pressure
If you do have chronic high blood pressure—not white coat syndrome—it’s important to manage and treat your hypertension to reduce your risk of cardiovascular conditions.
If you have elevated (between 120–129/less than 80) or stage 1 (between 130/80 and 139/89) hypertension, healthcare providers typically recommend lifestyle changes as the first-line approach. Lifestyle changes focus on improving cardiovascular health and taking on conditions that raise risk. Examples include:
If lifestyle changes don’t help lower your blood pressure, a healthcare provider will consider prescribing you medications. These should be taken daily, typically at consistent times. Your prescribing healthcare provider will offer more detailed instructions and monitor your blood pressure.
Medications for Hypertension
Summary
White coat syndrome arises when you get abnormally high blood pressure readings in a healthcare setting. It is a stress reaction that causes blood pressure spikes that can make it seem as though you have high blood pressure when, in reality, they’re temporary spikes.
Developing relaxation methods in the office or clinic and opting for home blood pressure monitoring can help you manage white coat syndrome. If you have high blood pressure, treatments include lifestyle changes and medications.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Briasoulis A, Androulakis E, Palla M, Papageorgiou N, Tousoulis D.White-coat hypertension and cardiovascular events: a meta-analysis.J Hypertens. 2016;34(4):593-9. doi:10.1097/HJH.0000000000000832Pioli MR, Ritter AM, de Faria AP, Modolo R.White coat syndrome and its variations: differences and clinical impact.Integr Blood Press Control. 2018;11:73-79. doi:10.2147/IBPC.S152761MedlinePlus.Measuring blood pressure. February 25, 2021.National Institute on Aging.High blood pressure and older adults. October 1, 2022.Pena-Hernandez C, Nugent K, Tuncel M.Twenty-four-hour ambulatory blood pressure monitoring.J Prim Care Community Health.2020;11:2150132720940519. doi:10.1177/2150132720940519.Cobos B, Haskard-Zolnierek K, Howard K.White coat hypertension: improving the patient-health care practitioner relationship.Psychol Res Behav Manag. 2015;8:133-141. doi:10.2147/PRBM.S61192National Heart, Lung, and Blood Institute.High blood pressure: symptoms. April 25, 2024.MedlinePlus.Relaxation techniques for stress. August 11, 2022.National Heart, Lung, and Blood Institute.High blood pressure: treatment. April 30, 2024.
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Briasoulis A, Androulakis E, Palla M, Papageorgiou N, Tousoulis D.White-coat hypertension and cardiovascular events: a meta-analysis.J Hypertens. 2016;34(4):593-9. doi:10.1097/HJH.0000000000000832Pioli MR, Ritter AM, de Faria AP, Modolo R.White coat syndrome and its variations: differences and clinical impact.Integr Blood Press Control. 2018;11:73-79. doi:10.2147/IBPC.S152761MedlinePlus.Measuring blood pressure. February 25, 2021.National Institute on Aging.High blood pressure and older adults. October 1, 2022.Pena-Hernandez C, Nugent K, Tuncel M.Twenty-four-hour ambulatory blood pressure monitoring.J Prim Care Community Health.2020;11:2150132720940519. doi:10.1177/2150132720940519.Cobos B, Haskard-Zolnierek K, Howard K.White coat hypertension: improving the patient-health care practitioner relationship.Psychol Res Behav Manag. 2015;8:133-141. doi:10.2147/PRBM.S61192National Heart, Lung, and Blood Institute.High blood pressure: symptoms. April 25, 2024.MedlinePlus.Relaxation techniques for stress. August 11, 2022.National Heart, Lung, and Blood Institute.High blood pressure: treatment. April 30, 2024.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Briasoulis A, Androulakis E, Palla M, Papageorgiou N, Tousoulis D.White-coat hypertension and cardiovascular events: a meta-analysis.J Hypertens. 2016;34(4):593-9. doi:10.1097/HJH.0000000000000832Pioli MR, Ritter AM, de Faria AP, Modolo R.White coat syndrome and its variations: differences and clinical impact.Integr Blood Press Control. 2018;11:73-79. doi:10.2147/IBPC.S152761MedlinePlus.Measuring blood pressure. February 25, 2021.National Institute on Aging.High blood pressure and older adults. October 1, 2022.Pena-Hernandez C, Nugent K, Tuncel M.Twenty-four-hour ambulatory blood pressure monitoring.J Prim Care Community Health.2020;11:2150132720940519. doi:10.1177/2150132720940519.Cobos B, Haskard-Zolnierek K, Howard K.White coat hypertension: improving the patient-health care practitioner relationship.Psychol Res Behav Manag. 2015;8:133-141. doi:10.2147/PRBM.S61192National Heart, Lung, and Blood Institute.High blood pressure: symptoms. April 25, 2024.MedlinePlus.Relaxation techniques for stress. August 11, 2022.National Heart, Lung, and Blood Institute.High blood pressure: treatment. April 30, 2024.
Briasoulis A, Androulakis E, Palla M, Papageorgiou N, Tousoulis D.White-coat hypertension and cardiovascular events: a meta-analysis.J Hypertens. 2016;34(4):593-9. doi:10.1097/HJH.0000000000000832
Pioli MR, Ritter AM, de Faria AP, Modolo R.White coat syndrome and its variations: differences and clinical impact.Integr Blood Press Control. 2018;11:73-79. doi:10.2147/IBPC.S152761
MedlinePlus.Measuring blood pressure. February 25, 2021.
National Institute on Aging.High blood pressure and older adults. October 1, 2022.
Pena-Hernandez C, Nugent K, Tuncel M.Twenty-four-hour ambulatory blood pressure monitoring.J Prim Care Community Health.2020;11:2150132720940519. doi:10.1177/2150132720940519.
Cobos B, Haskard-Zolnierek K, Howard K.White coat hypertension: improving the patient-health care practitioner relationship.Psychol Res Behav Manag. 2015;8:133-141. doi:10.2147/PRBM.S61192
National Heart, Lung, and Blood Institute.High blood pressure: symptoms. April 25, 2024.
MedlinePlus.Relaxation techniques for stress. August 11, 2022.
National Heart, Lung, and Blood Institute.High blood pressure: treatment. April 30, 2024.
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