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White Coat Syndrome: A Stress Response in Disguise

  • lmb523
  • Sep 25
  • 4 min read



White coat syndrome, also called white coat hypertension, is when your blood pressure reads higher in a medical setting than it does at home or in everyday life. At home, a healthy reading is usually below 120/80. Some people experience spikes that make their pressure look higher than it really is when they are seeing a doctor.


This can be a problem because every year, about 5% of people with white coat syndrome go on to develop actual high blood pressure. An inaccurate reading may also lead to unnecessary medication, or a doctor thinking your current treatment is not working when it actually is.


The average blood pressure reading for adults is considered to be less than 120/80 mmHg. This is based on the following guidelines from the American Heart Association: 

  • Normal: Systolic (top #) less than 120 and diastolic (bottom #) less than 80 

  • Elevated: Systolic between 120 and 129 and diastolic less than 80 

  • Stage 1 Hypertension: Systolic between 130 and 139 or diastolic between 80 and 89 

  • Stage 2 Hypertension: Systolic 140 or higher or diastolic 90 or higher 


It's important to note that these are just general guidelines, and individual blood pressure readings may vary depending on factors such as age, gender, and overall health. It's always best to consult with a healthcare professional for personalized advice on blood pressure readings. 


White coat syndrome is very real. Researchers have studied white coat syndrome for decades, and their findings consistently show that the stress or anxiety of a medical visit can raise blood pressure temporarily.

White coat syndrome can be dangerous, depending on your situation. For some people, the condition is harmless. But in others, it may reflect an underlying tendency toward higher blood pressure or cardiovascular problems.


Studies suggest that people over 60 who already have health risks—like diabetes, obesity, or a past heart attack—may have up to twice the risk of heart issues if they also have white coat syndrome. Still, experts believe the risk may come more from those existing conditions than from the syndrome itself.


Anyone can experience it, but it is most common in:

  • People over 50.

  • Women.

  • People who were recently told they have high blood pressure.

  • People who are overweight.

  • People who do not use tobacco.


Estimates say between 15% and 30% of people diagnosed with high blood pressure have white coat syndrome. It can also affect people without hypertension. There are usually no obvious symptoms other than your blood pressure is higher at the doctor’s office, but normal elsewhere.


The cause is often anxiety or nervousness in a medical setting. Just walking into the clinic, waiting for the exam, and then seeing the cuff go on your arm can trigger your body’s natural “fight or flight” stress response. Your heart rate and blood pressure rise automatically, even though you are not in danger.


This reaction can cause:

  • Stiffening of arteries.

  • Poorer blood vessel function.

  • A greater chance of developing left ventricular hypertrophy

  • Increased risk for having diabetes.

  • Increased risk of having long-term high blood pressure.


Blood pressure also changes naturally throughout the day depending on things like time, rest, activity, and stress level, which is why accurate readings are so important.


To confirm white coat syndrome, doctors usually need to see at least three high office readings (140/90 or higher), combined with normal readings at home or during a 24-hour monitor (under 135/85). Home monitoring or ambulatory monitoring is the most reliable way to separate true high blood pressure from white coat hypertension.


White coat syndrome does not usually go away on its own. For many people, it continues for years, even with the same doctor. That’s why long-term monitoring is important.


Treatment often includes:

  • Checking your blood pressure regularly at home with a reliable monitor.

  • Lifestyle changes like eating less salt, maintaining a healthy weight, getting regular exercise, and not smoking.

  • In some cases, blood pressure medication if other cardiovascular risks are present.


You may be able to bring your blood pressure closer to your true level with a few strategies:

  • Build a good relationship with your healthcare provider, or switch to one you feel more comfortable with.

  • Write down questions before your appointment so you are not worried about forgetting.

  • Leave early so you are not rushing or stressed when you arrive.

  • Avoid caffeine, smoking, or exercise in the half hour before your visit.

  • Practice relaxation, like deep breathing, while waiting for your exam.


People with white coat syndrome do face a slightly higher risk of heart problems than those with completely normal blood pressure. However, research shows that people taking blood pressure medicine do not seem to face extra risk compared with others who have normal readings. The key is accurate monitoring and managing any other health risks.


The best way to reduce your chances of white coat syndrome is through communication and comfort. Feeling at ease with your provider can make a big difference. The calmer you feel during the exam, the closer your reading will be to your true everyday blood pressure.


Proverbs 12:25

"Anxiety weighs down the heart, but a kind word cheers it up."

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