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Is My Doctor Making My Blood Pressure Rise?

Question

Lately, I can feel my heart begin to race like mad the minute I step into a doctor's office and, not surprisingly, my blood pressure has been high. Is there a white-coat syndrome? If so, why at the age of 55 am I so uneasy about a doctor's visit?

-- Pamela Russell

Answer

Yes, there certainly is a well-recognized phenomenon called "white-coat hypertension" in which blood pressure increases when it's taken in the doctor's office. The anxiety that causes your blood pressure to rise is probably a conditioned response to seeing the doctor and, perhaps, to what physicians have told you on past visits. The big question, of course, is how do you know for sure that your blood pressure goes up only in the doctor's office? Since high blood pressure itself generally doesn't cause any symptoms, there's no way for you to confirm that your pressure is otherwise normal unless you're checking it regularly at home. To be sure that the high blood pressure readings you're getting during your physician visits are the transient results of your anxiety, I suggest you rent or purchase a blood pressure monitor, if you don't already own one, so you can keep track of it at home in the future. If you're doing home monitoring, check your blood pressure at least twice a day, at random times, and keep a log of your results.

An interesting study published in the American Journal of Hypertension found that white-coat hypertension is much less likely to occur when a nurse rather than a doctor measures blood pressure. However, the study also concluded that to get a truer picture of blood pressure, the patient should wear an ambulatory device that takes readings throughout the day and night.

Another intriguing finding indicates that white-coat hypertension may be a sign of early heart damage and raises the question of whether it should be treated. In December 2001, the Archives of Internal Medicine published the results of a study by a group of Italian researchers that found enlargement of the heart's left ventricle was common among patients with white-coat hypertension.

This change may indicate an increased risk of heart attack and stroke. So far, there's no medical consensus on whether this new evidence means that patients with white-coat hypertension should be treated for high blood pressure. Either way, I think it's still a good idea to eat a wholesome diet and maintain a healthy weight, exercise regularly, and practice breathing exercises and other relaxation techniques. Since white-coat hypertension may indicate an exaggerated response to stress, you may need to find a way to manage it.

By Andrew Weil, M.D.