White coat hypertension is a type of high blood pressure that does not display consistent symptoms. White coat hypertension is unusual in that the symptoms manifest only when someone with the condition has their blood pressure tested by a doctor. This can be a problem because it means someone with the condition may receive hypertension medication that they do not actually need.
This white coat effect occurs because blood pressure is not a constant measurement. A person’s blood pressure is in constant flux during the day and night, as a response to environmental, physical, and mental effects. Feelings of anxiety or stress, for example, can increase blood pressure. People who become extremely tense when visiting the doctor tend to experience the white coat effect due to their anxiety.
The white coat effect is specifically defined as having a blood pressure reading of 140/90 mmHg or higher only when visiting a doctor. The white coat effect can increase blood pressure readings by up to 10 mmHg for the systolic reading, and up to 5 mmHg for the diastolic reading. Nearly 17% of adults experience one or more episodes of white coat hypertension in their lives. In addition to this phenomenon, up to 10% of adults may have a similar condition called masked hypertension. People with this condition experience discrete episodes of hypertension in everyday life, but consistently have normal blood pressure readings when they visit a doctor.
Both of these conditions were once considered to be harmless, with no long-term health risks, but the opposite is now known to be true. People with either white coat hypertension or masked hypertension have an increased risk of developing consistently high blood pressure. As a result these people may also have an increased risk of stroke or heart attack later in life.
There is no specific treatment for white coat hypertension. Medication is not usually an option, since the person with the condition has normal blood pressure readings most of the time. The only option for most people is to try and make an effort to relax and minimize anxious feelings when visiting their doctor for a blood pressure reading.
In addition, people who are suspected to have masked hypertension or the white coat effect are usually encouraged by their doctor to use a blood pressure monitor at home. With a home blood pressure monitor they can then obtain a dozen or more readings over the course of several days. Once these readings have been obtained a doctor can determine whether hypertension treatment is needed.