White Coat Syndrome

white coat syndrome

Most of us feel quite uncomfortable when visiting a doctor’s office. The atmosphere is always strict, and, since childhood, you may remember nothing good ever comes from visiting doctors. They always push and prod until you wince with pain, as if they know where it’s going to hurt the most. So whenever you enter their office, you remember all those times that brought you pain, and even when they smile at you, it’s hard to relax completely.

For most people, this fear of doctors is nothing but a small discomfort. However, some individuals develop a so- called “White coat syndrome.” This syndrome stems from  childhood fear of doctors and can spell lots of trouble for you. “How?” – you might ask. Well, white coat syndrome is also known as white coat hypertension, meaning that, whenever a person sees a doctor in a white coat, or even enters a clinic, their blood pressure begins to rise.

This can provide doctors with very misleading results, making them think the patient might have mild hypertension. While in reality, the patient might be completely healthy. Moreover, the medications they prescribe might make the patient  feel unwell. If a person takes antihypertensive drugs while having normal blood pressure, the blood pressure will become sub-normal and make him/her feel faint.

Symptoms of White Coat Syndrome

White coat syndrome (otherwise known as white coat hypertension) is a condition where the patient exhibits elevated levels of blood pressure when they see a doctor in white coat. This phenomenon has been linked to anxiety that some people experience when they visit a clinic. This can be very troublesome and lead to incorrect diagnosis and treatment.

There is also a contrasting phenomenon called “masked hypertension”. If the patient has this condition and when visiting a doctor, the patient  experiences the blood pressure dropping to normal levels, while being elevated throughout the day. This can prevent the patient from receiving treatment since the doctor might not suspect that something is amiss.

Making a Correct Diagnosis

Studies show that as many as 15%-30% of people who are thought to have mild hypertension, in truth, have normal blood pressure when not exposed to a clinical environment. Moreover, there is no correlation between the age or sex of the patient and the rate at which this condition appears.

In order to exclude false positive results, patient self-measurement or ambulatory blood pressure monitoring is used. However, even those methods are not foolproof since blood pressure is still affected by daily variables such as stress, physical activity, and duration of sleep.

In another study conducted by Turkish scientists, the blood pressure of 438 patients was elevated. This study revealed that taking blood pressure in clinical settings produces a considerable number of false-positive results:

  • 38% of the people had normal blood pressure
  • 15% had sustained hypertension
  • 43% had white coat hypertension
  • 2% had masked hypertension.

These results show that, in this particular study, 45% of the cases resulted in measurements of false blood pressure as a result of being taken in clinical settings. This presents a serious issue since this means taking blood pressure in clinical settings yields unreliable results. This is the reason why 24 hour ambulatory monitoring should be compulsory before antihypertensive treatment is prescribed. This will prevent healthy people from taking drugs that they don’t need. It also helps to identify people with masked hypertension,  otherwise they would go untreated.

Moreover, the same study showed that, even people who are using antihypertensive drugs and have normal blood pressure at home, may exhibit white coat hypertension, which makes it difficult for the doctor to evaluate the effectiveness of the treatment.

Should White Coat Syndrome be Treated?

There is still debate as to whether patients with white coat syndrome should receive any kind of treatment. The majority of scientists agree that patients with “white coat” syndrome should not receive any kind of antihypertensive therapy since this may lead to hypotension. However, patients with white coat hypertension should still be more wary and check their blood pressure more often as, statistically, they are more prone to developing heart disease than people who are normotensive.

 

 

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