What Is White Coat Syndrome?

White coat syndrome, also known as “white coat hypertension” or “white coat effect,” refers to a phenomenon in which a person's blood pressure readings are higher when measured in a clinical or medical setting, such as a doctor's office or hospital, compared to their typical blood pressure levels outside that environment.¹

This increase in blood pressure is often attributed to anxiety, nervousness, or stress that some individuals experience when interacting with healthcare professionals or being in a medical setting. Many individuals experience this problem whenever they're being monitored by a healthcare professional, even those without hypertension. 

Why do you panic when a blood pressure check is recommended?

White coat syndrome sheds light on why individuals react defensively whenever they are asked to have their blood pressure monitored. Most reply with the words, "No I'm not hypertensive, just having a headache, that's all." This fear and panic could cause them to experience a rise in blood pressure, resulting in a falsely high result, especially on the first reading. Some individuals comment that whenever they check their blood pressure at home or any other place, it is usually normal, but once the physician or doctor checks it for them, it is always elevated.

Prevalence of white coat syndrome

About 15% to 30% of patients with increased office blood pressure are known to have white coat syndrome.² This condition is often found among:

• People assigned female at birth (PAFAB)
• older adults
• non-smokers
• patients recently diagnosed with high blood pressure
• Pregnant individuals

The importance of understanding white coat syndrome

The misdiagnosis of people with white-coat hypertension as being truly hypertensive can result in them being penalised for employment and insurance rating, as well as being prescribed unnecessary lifelong treatment with potential side effects that may be seriously debilitating, especially in the elderly. Moreover, failure to identify the condition results in a large expenditure on unnecessary drugs. It is necessary to get the individual comfortable around the healthcare professional by first engaging them in non-medical discussion, using a starter conversation about their activities and fun, before examining their blood pressure. Also, some hypertensive individuals may have a false normal blood pressure reading when checked in a medical environment or by a physician or nurse; this is termed masked hypertension.³

Causes of white coat syndrome

• Anxiety due to a medical appointment
• Fear of the medical environment
• Fear of being diagnosed with a medical condition
• Fear of getting prescribed medical treatment in the case of a positive result

Symptoms of white coat syndrome 

• Elevated blood pressure reading
• Increased heart rate
• Feeling of nervousness

Diagnosis of white coat syndrome 

This is diagnosed when a patient's blood pressure at the hospital or medical environment differs from that taken from a different environment like their home, on several tests. Patients who showcase white coat syndrome could be mistaken for being truly hypertensive. For this reason, there is a need for a proper diagnostic method to prevent unnecessary initiation of anti-hypertensives in those who are not hypertensive. For hypertensive persons with this syndrome, an improved diagnosis would mitigate a physician's potential interpretation that their medications are ineffective and reduce the chances of their prescription being altered. 

The employment of ambulatory blood pressure monitoring is also a good choice for identifying and reducing white coat syndrome. Ambulatory blood pressure reading (ABPM) involves regularly checking blood pressure readings. It is thought to be able to lessen the "white coat hypertension effect" that a patient may experience when having their blood pressure examined in a professional environment.

White coat hypertension can be differentiated from chronic hypertension by the presence of signs such as headaches, chest pain, and fatigue. These symptoms are expressed in chronic hypertension but are absent in white-coat hypertension.

The implication of white coat syndrome on health 

• Misdiagnosis, in which the individual is assumed to be hypertensive when they are not 
• Individuals with untreated white coat hypertension have an increased risk of heart attack and stroke 
• High likelihood of death from heart disease 
•  Possible undetected medical conditions 
• Unnecessary prescribed medications/treatment  

Management

• Individuals should ensure their home blood pressure monitoring machine is functional and gives accurate readings
• Monitor  blood pressure at different intervals and at non-medical settings to establish the absence of hypertension 
• Physicians should try to calm the individual and also reassure them about their health before blood pressure monitoring
• Exercise to get relaxed and ease stress
• Dialogue with the physician on other topics  to get comfortable before blood pressure monitoring

Tips to prevent white coat syndrome 

• Request to speak with a physician you are more comfortable with
• Build trust with healthcare professionals 
• Reduce anxiety before going for medical visits 
• If you are hypertensive, always take your medications as prescribed 

Summary

White coat syndrome, simply put, is a condition in which you feel nervous or very anxious around healthcare professionals, that is, doctors or nurses. This is called the white coat syndrome because nurses and doctors are mostly seen in white ward coats. This feeling may, in turn, affect the blood pressure reading taken at that particular time. In some individuals, the effect is seen as increased blood pressure above normal (hypertension), while in others, it presents as lower values (masked hypertension). White coat syndrome tends to interfere with result interpretation if not properly diagnosed. It is very important to differentiate white coat syndrome from hypertension to prevent initiating the wrong therapy in individuals who are not hypertensive. Individuals should learn to be open and free with their physicians, as this will enable a better assessment of their health conditions. Understanding the causes and implementing appropriate management strategies ensures accurate blood pressure assessment, reducing the risk of misdiagnosis and unnecessary treatment.

FAQs

Is white coat syndrome an anxiety disorder?

No, white coat syndrome is not an anxiety disorder. It's a physiological response to anxiety and stress in medical settings, specifically causing elevated blood pressure during clinical visits.

How do you know if you have white coat syndrome?

Suspect white coat syndrome if your blood pressure is consistently higher during medical appointments but normal in non-medical settings. Confirm by monitoring your blood pressure at home and comparing the readings. If it's significantly lower outside clinical settings, you may have White Coat Syndrome.

Does white coat hypertension need medication?

White coat hypertension usually does not require medication. It's a transient response to anxiety and does not indicate chronic hypertension. Lifestyle changes and monitoring are typically sufficient for management. Medication is considered for chronic hypertension with consistently high readings in various settings, as determined by a healthcare provider.