Could white-coat hypertension harm your heart?

For most people, going to the doctor is usually a bit nerve-racking. But for some, the stress of a medical appointment triggers a temporary rise in blood pressure. If that’s the case for you — and if your blood pressure is normal at home and in other nonmedical settings — you may have what’s known as white-coat hypertension. Now, a large study suggests that people with this condition face a greater threat of heart disease than people whose blood pressure readings are always normal.

According to current guidelines from the American College of Cardiology and the American Heart Association, normal blood pressure is defined as less than 120/80. High blood pressure is 130/80 and higher.

“If your blood pressure goes up under the relatively nonthreatening situation of seeing a doctor, then what might happen if you’re cut off on the highway, or experience a challenging family or work circumstance?” says Dr. Randall Zusman, a cardiologist at Harvard-affiliated Massachusetts General Hospital.

Everyone’s blood pressure fluctuates constantly throughout the day. But people with white-coat hypertension may experience more frequent and higher spikes. About one in five people has the condition, which doctors typically don’t treat with medication.

The white-coat effect

For the study, researchers pooled findings from 27 studies involving more than 64,000 people in the United States, Europe, and Asia. Compared with people whose blood pressure was normal both at the doctor’s office and at home, people with untreated white-coat hypertension had a 36% higher risk of heart attack, stroke, and other heart-related events. They were also twice as likely to die from heart disease.

However, people taking blood pressure medication whose blood pressure still rose at the doctor’s office (a phenomenon known as the white-coat effect) did not have a higher risk of heart disease. The study was published June 10 in Annals of Internal Medicine.

According to Dr. Zusman, the findings lend further support for treating people with white-coat hypertension. Research suggests that the condition nearly always progresses to sustained high blood pressure.

What you can do

Treatment doesn’t necessarily mean taking blood pressure medication, however. “Losing weight, exercising, limiting salt, and not smoking are all associated with better blood pressure control. I certainly encourage people to do all those things, whether they have intermittent or sustained high blood pressure,” says Dr. Zusman.

Sometimes, even determined efforts to make these changes aren’t sufficient. If lifestyle changes aimed at controlling hypertension can’t bring your blood pressure down to a normal range, there are many safe, effective medications that can help.

Dr. Zusman advises all of his patients to use a home blood pressure monitor to make sure their treatment is working. “I also have them bring their device in and watch them take their blood pressure to make sure they’re using the monitor correctly,” he says. Doctors often suggest checking your blood pressure once or twice a day for a week or so right after starting or changing medications. After that, two to three times a week at different times of the day is a good idea, says Dr. Zusman.

Related Information: Harvard Heart Letter

Comments:

  1. Kimberly B Tuomi

    Notice the picture of the woman getting her blood pressure taken…her back is not supported and her arm is down. Looks like she is on an exam.table which means her legs are dangling.
    The problem is people are quickly seated on an exam table, talking or answering questions, feet need to ge on the ground and back supported and don’t take it till at least 3 min are past after seating. Take it twice if necessary and use the right size cuff!

  2. Judith Klingels

    Totally in agreement with you Vik.

  3. mohammad momen

    nice and new, thanks.

  4. Linda McKee

    I want to thank Vin Khanna for clarifying the difference between relative and absolute risk. Too often doctors use only relative risk statistics which scare patients into compliance, while the poor patient has no idea of what their real risk is. I also appreciate the pointing out that “blood pressure thresholds rise with age. There is no evidence of improvement in morbidity or mortality, for example, in adults over age 60 of treating a blood pressure that is below 150/90 (JNC 8).” The parameters of acceptable blood pressure, along with cholesterol and others have lowered to the point of absurdity. This lowering of acceptable parameters has been very lucrative for pharmaceutical companies.

  5. David Beauregard

    I have experienced “white coat hypertension” for many years. I experienced a heart attack on April 4th, 2018. The Cardiologist inserted four stents in arteries around my heart. I have consistently taken medications to control hypertension. I exercise 3-4 times weekly, have reduced my salt and my weight has been the same 173 for the last several years. What, if anything, have I missed that I should have been doing to control my Hypertension? Thank you. David Beauregard

  6. Margie Lee

    Some of these people may have had traumatic medical treatment in the past or are worried about a current medical condition. They may not have elevated blood pressure under other circumstances, like on the road.

  7. Peter Sinclair PhD

    But is it really the white coat or seeing the doctor. Or, the drive to the doctor’s office and the inevitable wait wait to be seen?

  8. Brian Nambale

    Thanks this is incredible

  9. James Williams

    informative

  10. Vik Khanna

    A very poorly written article.

    Her claim that risk of heart disease rises 36% is a meaningless exclamation of relative risk. Unless absolute risk is also stated, the relative risk is completely without context. Since the author is does not understand this or willfully ignored it, I’ll explain: if a person’s absolute risk of a heart attack is 5%, and risk rises by the amount noted, the new level of absolute risk is 6.8%. Not exactly earth shattering.

    Further, blood pressure thresholds rise with age. There is no evidence of improvement in morbidity or mortality, for example, in adults over age 60 of treating a blood pressure that is below 150/90 (JNC 8).

    Like many things that the medical industry produces, this is meant to frighten people into thinking that they are diseased or in need of treatment.

    • Fadi

      You are correct but this depends on the audience. She could have went on to explain what a heart attack is or what the heart itself is. For people who study medicine or health sciences this should be a clear giveaway (that she is talking about relative risk). She does indeed not mention what the absolute risk is but that is very general and can be found in multiple websites. This is not what the article is focusing on in my opinion

    • John Julian

      Vik makes a very good point. We often hear these large percentages of increase risk, but if the initial risk is 1% and a stated increase is 50% the actual risk is elevated to only 1.5%. At 100% it’s 2%. What often a person is led to believe is that his or hers risk is 50% or maybe even 100% which means a sure fact that they are going to succumb to that particular ailment if they don’t take action! I’m not advocating people ignore they’re health and not make a strong effort to lead a healthy life-style and take medications if needed, but the medical field needs to present findings in a honest manner that we can understand.

    • Chris

      Vik Khanna thank you for that reply!

    • Elias

      Thank you Vik that was a very helpful and clearly demonstrated response. I had not made the connection between absolute and relative risk in this context. Thank you for saving me time in reading further.!

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