The Basics on White Coat Syndrome

Even though your healthcare provider has your best interest in mind, you may experience a bit of anxiety at doctor’s appointments.

For some people, this fear can even cause a phenomenon called white coat syndrome: Their blood pressure rises at the doctor’s office, leading to a high blood pressure reading even if they otherwise have healthy blood pressure levels.

If you find that your blood pressure increases only happen when you’re in a medical setting, it may be helpful to learn about managing your anxiety.

On the other hand, if you are diagnosed with high blood pressure (hypertension), lifestyle changes and, if necessary, blood pressure medication can help treat the condition to reduce your risk of medical complications.

In this article, I’ll explain what white coat syndrome is as well as the symptoms, causes, and treatment of white coat syndrome.

I’ll also discuss the difference between white coat syndrome and hypertension and when to talk to a physician about any concerns about blood pressure. 

What Is White Coat Syndrome?

White coat syndrome (also called white coat hypertension or the white coat effect) is a condition where people with otherwise normal blood pressure levels have high blood pressure at the doctor’s office.

It’s called “white coat syndrome” because healthcare providers often wear white coats.

Studies show that people who experience the white coat effect are at an increased risk for heart attack or stroke than people who have normal blood pressure readings at the doctor.

A spike in blood pressure at the doctor’s office can happen to someone with normal range or high blood pressure.

So if you have a high BP reading, your physician will likely want to monitor your blood pressure to determine if you have hypertension. 

Symptoms of White Coat Syndrome

The most significant sign of white coat syndrome is high blood pressure at doctor’s appointments.

A high blood pressure reading is defined as 130/80 mm Hg or higher.

Other symptoms of white coat syndrome are less clear.

However, because white coat syndrome can be associated with anxiety, you may experience a racing heart, sweating, or a general feeling of being on edge. 

Causes of White Coat Syndrome

The exact causes of white coat syndrome are uncertain.

Anxiety for any reason can trigger a temporary increase in blood pressure.

So at first, experts believed anxiety about seeing the doctor caused white coat hypertension. 

Now some evidence suggests that white coat syndrome may be an early sign of hypertension.

That’s why it’s important to monitor your blood pressure—and manage your anxiety—if you experience white coat syndrome. 

Treating White Coat Syndrome

If your physician is concerned about your white coat syndrome, they will monitor you for hypertension.

Since it can be challenging to get an accurate reading with a blood pressure cuff in people with white coat hypertension, your provider may encourage you to return for another appointment or ask you to monitor your own blood pressure at home. 

If you are diagnosed with hypertension, your doctor may encourage lifestyle changes, prescribe medication, or recommend both treatments.

Or if you have white coat syndrome due to anxiety, the following coping tools may help reduce your stress and, in turn, provide a more accurate blood pressure reading at your doctor’s office.

Practice stress relief

If you tend to experience anxiety, work on managing your stress between doctor’s visits.

The below evidence-based coping mechanisms may help reduce stress and, hopefully, your blood pressure readings: 

• Progressive muscle relaxation: This exercise involves relaxing each muscle in your body, one group at a time. To start, take a deep breath. Then, beginning at your head, tighten and then relax each muscle group one by one, slowly working your way down to your toes.

• Deep breathing: When you feel anxious, focus on your breath. Deep breaths—allowing your belly to fully expand and then completely exhaling that breath—can calm your body and mind and reduce stress levels.

• Exercise: Whether you go for a walk, take a yoga class, or hit the gym, physical activity has been shown to decrease stress, so try to incorporate exercise into your routine on a regular basis. 

• Seeking support: Everyone needs support from time to time. If you’re struggling with stress, it can be helpful to share your feelings with a trusted loved one or a psychotherapist.

Calm yourself down/relax

If you feel nervous while waiting for your provider to take your blood pressure, try to calm yourself down.

Taking deep breaths, listening to soothing music, or visualizing something relaxing may help. It may also help to let the provider know you’re feeling nervous.

Or you can ask the doctor or nurse to wait until later in the appointment (when you may feel more at ease) to take your blood pressure. 

Move rooms

If you’re in a loud or crowded area, ask the person taking your blood pressure if you can move to another room.

Dimming the lights in the room may also help you calm down. 

Change your focus

Distraction can be another helpful tool for white coat syndrome.

While you shouldn’t talk during a blood pressure reading, you can look around the room or think of something else (ideally something or someone that helps you feel happy or calm). 

Difference Between White Coat Syndrome and Hypertension

It can be difficult to understand if you have white coat syndrome, hypertension, or both. 

It would be helpful to check your blood pressure at home at different times during the day on different days, and bring a log of those values to your appointment.

If your blood pressure readings are typically normal except when you’re at the doctor, you may have white coat syndrome without underlying hypertension.

To be sure, your medical provider will continue monitoring your blood pressure to see if you develop hypertension over time.

This monitoring will also help determine if your white coat syndrome is an early sign of high blood pressure or another underlying condition. 

If you have hypertension, your blood pressure will remain consistently elevated, whether you are at a healthcare provider’s office or in another environment.

When to See a Doctor

No matter what causes it, high blood pressure increases the risk of developing medical complications like heart disease and stroke.

If you’re concerned about your blood pressure, talk to your doctor, who can diagnose and treat you. 

Likewise, speak to your doctor if you’re struggling with anxiety.

It’s normal to feel anxious from time to time, but if your worries interfere with your everyday life, treatment such as therapy, medication, or both can help you manage this anxiety.

How K Health Can Help

Did you know you can get affordable primary care with the K Health app? Download K Health to check your symptoms, explore conditions and treatments, and if needed text with a provider in minutes. K Health’s AI-powered app is based on 20 years of clinical data.