Derek Burnett
Derek Burnett is a Contributing Writer at Bottom Line Personal, where he writes frequently on health and wellness. He is also a contributing editor with Reader’s Digest magazine.
Most people understand the importance of monitoring their blood pressure so they’ll know if they have hypertension and can treat it to stave off the serious health effects of chronic untreated high blood pressure. But between 15% and 30% of patients get a different reading depending on whether their blood pressure is taken at home or in a professional healthcare setting.
When the blood pressure reading is higher in a doctor’s office, clinic, or hospital than at home, we say that the person is experiencing “white-coat hypertension,” which refers to a temporary increase in blood pressure associated with the presence of a healthcare professional (even though most US doctors no longer walk around in white coats). As you might imagine, an abnormally high reading while in the doctor’s office can be problematic. A doctor with a patient already on a hypertension medication whose blood pressure is well controlled in daily life but spikes when in the office could increase the dosage, unknowingly exposing the patient to the risk of dangerously low blood pressure, called hypotension.
Can anxiety cause high blood pressure in the doctor’s office? There’s reason to think so. Even if you don’t consciously feel nervous around healthcare professionals, subtle physiological changes could occur that elevate your blood pressure when you’re in the “hot seat.” The effects of anxiety on blood pressure can be so subtle, in fact, that experts recommend that when you’re taking your blood pressure at home, you do so in a silent room with nobody talking and no TV on, since even seemingly innocuous subject matter can stimulate mild anxiety.
Obviously, figuring out that a patient has white-coat hypertension requires a set of blood pressure readings that have been taken outside the doctor’s office for comparison. That’s one of the reasons that anyone who’s gotten a high reading in a doctor’s office should begin monitoring their pressure at home.
Log your home readings for a couple of weeks. If there’s a significant difference between the result you’re seeing at home and your readings in the healthcare setting, talk to your doctor to figure out what’s happening. It could be that your home device doesn’t fit properly or is calibrated differently than the one in your doctor’s office. You can bring your device to your doctor’s office, take separate readings using your monitor and theirs, and compare the two results. If they’re similar and higher than what you get at home, you may have white-coat hypertension. To make sure, your doctor will probably order 24-hour monitoring for a time with a special device that provides a continuous feed of data. If the result on your device is lower than that using the doctor’s equipment, then you probably need to shop for a different home monitor that will produce a more accurate reading for you.
Interestingly, about the same percentage of people who have white-coat hypertension experience its opposite, a condition called masked hypertension. With masked hypertension, your blood pressure appears normal in the healthcare setting but abnormally high when taken at home. While the danger of white-coat hypertension is that you’ll be overtreated for the condition, the risk with masked hypertension is that you’ll go undertreated. As with white-coat hypertension, someone experiencing masked hypertension should first rule out that their home device is responsible for the discrepancies in readings, by following the same steps suggested above. To confirm that you have masked hypertension, your doctor will probably want to have you do 24-hour blood pressure monitoring, especially since the rise in blood pressure of people with masked hypertension often occurs during sleep.
Recognizing either white-coat hypertension or masked hypertension will help your doctor better manage your blood pressure. Remember, though, that controlling your blood pressure is not just up to your doctor. Fortunately, despite being such a serious condition, hypertension is something over which we as patients usually do have a great deal of control. Adjusting your diet—especially cutting back on sodium and reducing alcohol consumption—is one of the best ways to lower blood pressure fast. Getting enough exercise and good sleep can also help, as can quitting smoking.
White-coat hypertension illustrates the connection between hypertension and emotional stress. But stress doesn’t just cause temporary spikes in blood pressure. When you experience stress, your body releases the hormones cortisol and adrenaline, which cause an immediate surge in blood pressure. That reaction is helpful in “fight-or-flight” situations, but if your job, relationships or financial circumstances are highly anxiety-producing, you may end up with chronic stress, in which your body never exits that fight-or-flight state of arousal. Constant exposure to those stress hormones can cause chronic, not just short-term, hypertension.
If you find yourself in a stressful situation—including a doctor’s visit— you might want to try breathing exercises to lower blood pressure. The simplest such exercise consists of just sitting still for five minutes, twice a day, during which you will be focusing on the rhythm of your breathing. You don’t need to do anything unusual. The important thing is that your concentration is focused on the in and out of your breath.
Another exercise to lower blood pressure is called box breathing. With that technique, you inhale for a count of four, hold your breath for four counts, and exhale for a count of four, and repeat. Box breathing for just five minutes helps many people regain focus, quiet their intrusive thoughts, and damper the body’s stress response. Other patients prefer what’s called a “body scan,” in which you lie on your back and, starting with your toes and working towards the top of your head, progressively focus your attention on each body part while remaining conscious of the rhythm of your breath. As you move your focus up toward the top of your head, remember to direct your attention both to the back and front of your body. This exercise can also be used to help you fall asleep at night.
