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A doctor in a whitecoat
Thanks: www.freedigitalphotos.net

Note: While creating our new website, I came across many good posts and articles that had been lost as time went on. Over the next few months, I am planning to revisit and re-release the most interesting ones.

I originally wrote this “White Coat Effect” article back in 2005. At the bottom, I have updated it with my experiences since then.



White Coat Effect

I have high blood pressure, also known as hypertension. Whenever I visited doctors, they told me that my blood pressure was high, but that it was probably due to the “white coat effect”.

It turns out it wasn’t … my blood pressure was high whether there was a white coat around or not. You can read this article if you want to know how I found out I really did have high blood pressure.

Word Spy defines white coat effect as:

white coat effect n. The elevation of a patient’s blood pressure readings caused by being in a doctor’s office or clinic, or by being in the presence of a physician.

(Update…) Below is a nice video, by Dr. Tytus explaining the issues surrounding white coat hypertension:

Competition

I think my white coat effect was due to competition.

I knew going into the doctor’s office that they would be taking my blood pressure, and a good result was lower numbers … just like when you go into a race, a good result is a lower time.

I also knew that high readings were bad … when the doctors would tell me that my readings were bad I felt that I had somehow failed (and steeled myself for the inevitable lecture about how high blood pressure is bad.)

I can feel my blood pressure rising just thinking about it! … that ripping sound as they prepare the cuff, then wrap it around my arm, then the phush … phush … phush sound as it inflates, and the sssss sound as it deflates.

The Double Pump

The icing on the cake is when the doctor is half way through the deflating, and you hear the phush … phush … phush inflating sound again.

At this point in time I can’t help thinking that they mustn’t be able to believe my blood pressure is actually that high, and they need to double check it. The double pump up is never a good sign.

Excuses Excuses

After reading the above, it should come as no surprise that I suffer from the white coat effect. What came as a bit of a surprise to me is that I also really do have high blood pressure. See the My high blood pressure story for more on that.

Monitoring

I now own a home blood pressure monitor and take my own blood pressure each day. (Well, I take it most days which is why I wrote the My Blood Pressure software to remind me).

Now when I go to the doctor, even with a bit of white coat effect, my readings are in the normal range!

Update – 2009

It has been over four years since I wrote this article, and believe it or not, the last time I visited my doctor I still had the white coat effect :oops:

For the three weeks prior to my doctor visit, I had been taking my blood pressure 3 to 4 times a day. My average home reading around 106/75, and never above 120/80. When my doctor took my blood pressure in her rooms, it was something like 135/85 :-o . She actually made the comment that it was a good thing that I had done the home monitoring so she knew not to worry.

Over the past five or six years, I have become much more aware of my blood pressure levels. I’m pretty good at predicting what my numbers will be at any time based on how I feel. I can still feel it going up just as my doctor starts taking a reading. I think I might have to learn meditation or something :)

Since writing that article, I have spoken to many people by e-mail to find the same thing happens to them. I think Kellie’s interview with Norman M. Kaplan, MD rang most true with me when she asked:

Kellie: What is white-coat hypertension?

Dr. Kaplan: Many people who have a moderate degree of hypertension in the physicians’ office, find that when they take their own blood pressure at home they are normal-tensive. Those people have white-coat hypertension. There is no real certainty that it’s a benign condition because the latest data suggests that many will go into usual hypertension, a number above 140 over 90.

That was me!

More reading

Kellie has also written a few news items about whitecoat and masked hypertension and anxiety and the white coat effect. We also published a story in one of our newsletters from Tom Dent who suffered from the white coat effect.

Any comments?

Do you get the white coat effect? How does it affect you? If you have any comments or feedback on this topic, please leave a comment below or e-mail me at: steve@my-health-software.com.

Thanks!

Steve

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6 Responses to “Steve and the white coat effect”

  1. KellieMyHS says:

    I also find my blood pressure is higher at the doctors office. I try hard to relax and not think about my blood pressure, but it always creeps up.

    I reviewed a study earlier in the year that shows that white coat hypertension is not harmless. Occasional spikes in blood pressure due to ‘white-coat’ can increase the risk for sustained high blood pressure.
    http://www.my-health-software.com/view/items/masked-whitecoat.html

    Steve would say the answer is to just avoid ‘white coats’ whenever possible! :)

  2. KHogen says:

    I get the same thing with my doctor, usually I am 10 or 20 higher. He says it is very common and normal.
    Steve, congratulations on getting your BP under control! :)

  3. Helen says:

    My doctor takes my blood pressure twice. Once when I first walk in and then after we have chatted for awhile. It is always lower the second time

    • Travis says:

      My doctor likes to talk a bit first, but I find the apprehension just raises my BP. He never takes it a second time … the good thing is my readings are still at normal levels. Over time I’ve found that ‘it is what it is’ thought before hand works best.

  4. leif Jenkinson says:

    The USCG “proved” my sort-of-high blood pressure was “white coat” because it was always high in clinic and never high on ship. That was in the 70s & early 80s. Fortunately, my family doctor became suspicious (and my readings were very high) in about 2005 and convinced me to take readings at home. They were just as high at home. Moral: things can change, especially as you approach 60’s (and put on weight), so confirm PB somewhere else than Drs’ office periodically.

  5. Jim says:

    My readings are always high in a Doctor’s office. Prior to a tooth extraction the dentist took my pressure with a reading of 240/129. After sitting for an hour it came down to 145/80 and he was able to proceed.

    After 35 yrs without a primary Dr and at 73 yrs of age, I decided it was time to make a selection. The first bp reading was 156/90. I plead my case with the readings I get at home and he recommended I bring my bp monitor my next visit for comparison. For the next month I took my bp several times a day and recorded in my health software. With 89 readings, a low of 95/59 a high of 136/70 and an average 121/69, armed with a print out and my bp monitor I went to see my Dr. My bp was 149/83 on his monitor and on mine. He diagnosed my white coat syndrome.

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