High blood pressure is no joke.  Having high blood pressure can have several negative effects on your health, many of which can lead to premature death.  HBP or hypertension, can lead to damaged or narrow arteries.  That in turn decreases blood circulation throughout the body.  It can weaken your arteries as well and result in an aneurysm, which can result in internal bleeding and ultimately, death. High blood pressure can also damage your heart causing heart attacks or heart failure.  It also can have a pronounced negative effect on the blood vessels in your brain.  This is what leads to stroke which is a prime risk factor of HBP.  It is also linked to both mild cognitive impairment and dementia.  And lastly, HBP can lead to kidney failure.  So if you have high blood pressure, it needs to be treated and lowered.

Using lifestyle changes to lower blood pressure is always preferable. Changing eating habits, starting to exercise and reducing stress are great ways to lower blood pressure.  If you don’t use lifestyle changes, then medications may be necessary.  But when the doctor takes your pressure and it comes out high, how accurate is that number?

Bella, age 63, was a client of mine last year.  Her doctor sent her because she had been having borderline high to high blood pressure.  Even with medication, when she went to her appointments, her readings were high.  However, when Bella’s neighbor, a nurse by profession, checked her BP, it was always 10-20 points less than the doctor’s readings.  Was it the different cuffs they used?  Not likely!  Bella had something known as White Coat Syndrome. This is when your blood pressure rises in reaction to seeing a doctor (many of them wear a white coat when they work).

White Coat Syndrome

As much as 20 percent of the population suffers from “white coat syndrome”.  This becomes a challenge for physicians seeking an accurate blood pressure reading. But, Nathan Consedine, PhD, a health psychology researcher at Long Island University says that, “a fear response in a health care setting is perfectly normal because most people associate hospitals and clinics with sickness and injury”.

“Fear is a response selected to promote immediate avoidance of a physical threat,” Consedine says. “Doctor’s offices and hospitals are places where bad things happen, so it’s not surprising that people avoid them.” It is interesting to note that a person with white coat syndrome may not feel anxiety, but the body, “at a low level, is ready to run away.”

These fears of doctors and medical establishments sometimes manifest themselves in other ways.  People sometimes faint when they need a blood test or see the needle on a syringe before receiving an injection.  I met someone who went for a routine colonoscopy and had to wait, as his anxiety about the test elevated his blood pressure up 70 points.  So this phenomenon is not rare.

What causes this?

The typical cause is being anxious at the doctor’s office, possibly over what the blood pressure reading will be or over the act of having blood pressure taken. People with “white coat hypertension” tend to have higher anxiety levels at the doctor’s office not only compared with people who have normal blood pressure, but also compared with those who have persistent hypertension.

Interestingly, people prone to white coat hypertension are not necessarily any more anxious in their overall lives than the average person. They seem to overreact specifically when they are in the doctor’s office. Age is another risk factor for white coat hypertension, which occurs more frequently in older people.

It’s not just in the doctor’s office.   There are also cases in which blood pressure might be elevated with one doctor who measures your blood pressure but not with another. In some people, blood pressure is not elevated if a nurse or technician measures, or if the person is wearing an ambulatory monitor (which measures blood pressure every 20 to 30 minutes over a day or two and stores the readings).

Anxiety about blood pressure can lead to a vicious cycle. Higher and higher blood pressures at the doctor’s office lead patients to obsessively measure their blood pressure at home. This in turn can lead to more anxiety and possibly artificially high readings even at home.

Other Factors

There are other things that temporarily can raise blood pressure at the doctor’s office.

Did you rush to your appointment?

If you are late and walk very quickly and then perhaps do a flight or two of stairs, you will increase your circulation and in turn, your BP will rise.

Use the bathroom

Make sure you use the bathroom before your appointment. When a person has the urge to go, stress hormones are released and your pressure automatically rises.  It can go up about 15 points just from that.

Caffeine

A serious dose of caffeine will also temporarily raise your blood pressure.  So a strong cup of coffee or an energy drink may inflate your readings.

Waiting room

Are you sitting in the doctor’s waiting room for a long time in over-anticipation of your visit?  That can certainly make someone anxious. And sitting with your legs crossed while your waiting can also make your BP go higher.

Research on White Coat Syndrome

Although some experts feel that having white coat blood syndrome is a benign condition, a study 2 years ago published in the Journal of the American College of Cardiology suggested that it is linked with an increased risk of cardiovascular disease.  A different study however, published last year in Europe showed that this condition only mattered in people over 60 with 3 other risk factors for Cardiovascular Disease.

On one of her visits to me, I spoke with Bella at great length. When I told Bella that her blood pressure may only be high when her doctor takes it, she asked me to check it.  Guess what?  After three readings over 3 minutes, she had perfectly normal blood pressure!

Try to work on the anxiety you are having about your blood pressure being takenIdentify your anxiety and confront it.  You can learn how to be more relaxed with your doctor.  High Blood Pressure can be a dangerous condition, but if you can identify that yours is only around the doctor, you won’t run the risk of treating a condition you don’t really have. Relaxing and keeping yourself from over-reacting to the presence of your doctor will “add hours to our day, days to your year and years to your life”.