'White-coat hypertension' isn't all in your head

  • Anxiety can lead to white-coat hypertension -- a spike in blood pressure when you visit the doctor.

    Anxiety can lead to white-coat hypertension -- a spike in blood pressure when you visit the doctor. Stock Photo

 
By Teri Dreher
Updated 5/15/2022 8:32 AM

I've met very few people who actually enjoy seeing a doctor. And the doctors I know don't take offense because they understand the anxiety their patients feel over a medical condition, or even a regular exam, is very real.

After all, going to a doctor is often associated with fear of the unknown. What will my doctor say to me about my weight? (And do I have to get on the scale?) Will my doctor find something wrong, or suspicious? Will my blood pressure be too high?

 

Some of these fears may sound irrational, but they're real nonetheless. The resulting anxiety usually manifests itself in higher blood pressure.

White-coat hypertension affects about one in five adults, studies suggest. They may have a normal blood pressure at home (defined as 120 or less systolic -- the top number -- and 80 or less diastolic), but it spikes in a hospital or doctor's office. It appears to be more common in women, older adults, nonsmokers, people with mild hypertension and those who are pregnant.

Survivors of sexual trauma may experience white-coat anxiety when it comes to certain procedures like pelvic exams. Don't agree to a pelvic exam unless there's reason, such as a periodic Pap smear, pregnancy or unexplained bleeding. Pelvic exams in women under age 21 are generally unnecessary.

White-coat anxiety may also arise from something called "sanctuary trauma," which is trauma that affects a person in a supposedly safe place, like school -- or a doctor's office. If you had an unpleasant or troubling experience with a doctor before, that could carry over into your relationships today with health care providers.

There are ways of controlling this feeling of anxiety and resulting hypertension. Here are some suggestions:

• Pick a health care provider you're comfortable with; for example, a lot of women prefer to be seen by women doctors.

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• Schedule your appointments at a time of day when you're most relaxed. For most people, that may be in the morning. Rushing to a doctor's appointment on your lunch hour or after work may contribute to white-coat anxiety.

• Take someone with you. It's good to be able to chat with someone while you're waiting.

• Use mindfulness to control your breathing and quiet your mind. If you have a smartwatch, it may have a feature that coaches you to breathe deeply for a minute.

• Mentally prepare for your appointment or procedure, and if you're feeling anxious share your feelings with your provider. Talking helps.

• Ask to have your vitals taken last, after you've perhaps had a good talk with your doctor. And if you don't want to get on the scale, weigh yourself at home and give them the number at the doctor's office.

                                                                                                                                                                                                                       
 

• Avoid drinking excessive amounts of water or doing physical activity just before getting your blood pressure checked because they can elevate your readings.

• Watch what you eat before a doctor's appointment, such as avoiding fatty, sodium-rich food for at least two days prior.

So, is white-coat hypertension a benign condition, or does it portend something more serious?

While it was once thought to be no big deal, it actually is. If your blood pressure goes up in the presence of a white coat it probably also goes up in response to other stresses. Studies have found that people with white-coat hypertension have a higher risk of heart attack and stroke than people whose blood pressure is normal when they visit their provider.

If you have white-coat hypertension, don't let your doctor brush it off. Monitor your blood pressure at home with an easy-to-use automatic cuff and write down the results. You can also ask your doctor about wearing a blood pressure monitor for 24 hours to track your readings when you're not in a doctor's office. The results can help determine whether your white-coat hypertension needs treatment.

Speaking of treatment, if you're prescribed blood-pressure medication, take it. It is said hypertension is the silent killer because often it has no symptoms. In some cases, that silence is deadly.

The bottom line when it comes to white-coat hypertension is trust. You should trust your doctor enough to have an honest conversation about it, and trust you will receive an appropriate response. If you don't feel that trust, it could be time for a new doctor.

• Teri Dreher is a board-certified patient advocate. A critical care nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). She is offering a free phone consultation to Daily Herald readers; call her at (847) 612-6684.

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