12 July 2011

'White Coat Effect” Is For Real

Are you a person that takes your blood pressure at home? If so is it consistently lower than that taken in the doctor's office? If so, you may have “white coat effect” (or syndrome if your prefer) or an alternate problem that you have not been allowed to rest for the five minutes before they take your blood pressure. In some offices and clinics, there is a lengthy walk before arriving at the office where the doctor will see you.

This walk can be just enough to start to raise your blood pressure, and then some nurses insist that they take your BP just as soon as you sit down. So just remember that both can affect you blood pressure and the combination can add to the measurement in the doctor's office. Of course, there is a third alternative for men – the nurse may be very attractive – sorry, we won't go there.

Researchers at Duke University and the Durham, NC VA Medical Center have completed a study that supports the white coat syndrome. The study reports that blood pressure readings were consistently higher in the doctors' offices than those taken at home or even in the research setting. While doctors generally rely on one or two BP readings to determine if the patients need treatment for high blood pressure or if it is controlled sufficiently by patients already on medications. This study points out that changes need to be considered.

The researchers felt that repeated measurements taken at home may help give a more accurate display of blood pressure management that a single reading in a doctor's office. The research findings support the idea that the stress of a medical exam can cause large elevations in blood pressure. The researchers also stated that blood pressure normally fluctuates from hour to hour and from day to day, but even knowing this, they were surprised by the large differences between clinic and home readings.

The message for patients is that it is extremely difficult for doctors to know if BP is in or out of control without having multiple measurements. Because of the large differences between clinic and home readings, it is important to take home readings with you to the doctor as this can help the doctor make better decisions for you. Also be aware the some doctors do not accept home BP readings and will ignore them – possibly to your detriment. So discussion beforehand may be necessary.

Read two separate reports of the study here and here.

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