“White Coat Syndrome is a medical condition that's characterized by an elevated blood pressure reading in the medical setting, for example, during a visit to a doctor's office or in the hospital while actually having normal blood pressure levels when measured in a non-medical environment,” says Dr. Khalid Al-Khafaji, a board-certified cardiologist with Northwest Medical Group.
Also known as White Coat Hypertension, the condition can be caused by fear, says Cynthia Spencer, oncology institute social worker at Methodist Hospitals.
“It’s fear of the unknown, fear of a diagnosis or fear of pain,” continues Spencer, noting that when individuals are placed in a fearful or stressful situation, their bodies cannot protect them, which translates into a physical response.
“White Coat Hypertension would be in the same family as anxiety and phobias and can cause feelings that are traumatic, scary and shameful. All three are mental health issues that are rooted in fear and can cause physical effects such as rapid breathing, elevated heart rate and increased blood flow, which all distress the cardiovascular and respiratory system.”
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And though the condition is temporary, it carries risks of misdiagnosis, says Al-Khafaji. For example, the tense patient can be diagnosed with hypertension and prescribed unnecessary medications that potentially carry adverse effects.
“These adverse effects include excessive lowering a person’s blood pressure and exposing them to the potential side effects of the medication,” he continues. “Some studies also have suggested that there’s actual cardiovascular risk as well."
Other studies suggest that the though higher blood pressure of White Coat Hypertension is usually temporary, it may signal a slightly higher risk for developing sustained hypertension, Al-Khafaji says.
Besides that, the increased anxiety can prevent patients from seeking needed medical treatment.
When a patient's blood pressure seems high, Al-Khafaji typically waits and retests after the patient has a chance to relax. That provides a more accurate reading that accurately reflect their health status and everyday blood pressure level.
Spencer recommends being honest about what you are feeling to your doctor and family members.
“Some fears are not preventable and some are. However, you can learn tools to get you through your fears,” she says. “Mental health therapists can help with specific tools for that particular individual. Exposure therapy is what I suggest to my clients. Instead of avoiding stressful situations, expose yourself until it gets comfortable and your bodies physical effects are not triggered.”
Practicing relaxation techniques such as deep breathing, meditation and progressive muscle relaxation before or during medical appointments can help to calm the patient and lower their blood pressure.
Al-Khafaji says that regular physical exercise in general helps lower stress levels and reduces cardiovascular risk.
“I usually tell people they require at least 30 minutes of moderate intensity exercise, aerobic exercise or brisk walking most days of the week,” he says. “That would help to improve the overall cardiovascular health.”
He also suggests that patients with White Coat Syndrome might consider using home blood pressure monitors to check their levels regularly.
“If they bring me their machine I can check them and calibrate them to make sure it's accurate and reliable,” he says. “That helps provide an accurate picture of their blood pressure outside the medical setting.”
Rushing to get to an appointment also can raise blood pressure.
Besides leaving enough time to get to the appointment, Spencer recommends deep breathing techniques, listening to relaxing music and using positive self-affirmations to keep blood pressure at normal levels.
Al-Khafaji emphasizes that White Coat Syndrome is not something to disregard.
“That’s why we tailor our approach based on the individual circumstances and the severity of their condition,” he says.
