High Blood Pressure & Kidney Disease - NIDDK

Diagnosis And Treatment Of White-coat Syndrome

Diagnosis of White-coat Syndrome

The individuals with white-coat syndrome can be characterized by normal blood pressure at all times except during a doctor's appointment or in a clinical setting. The individuals can be further characterized by the absence of a decrease in blood pressure with the intake of antihypertensive drugs. Organ damage is absent in the absence of hypertension. There is minimal risk of cardiovascular damage in such individuals. The following methods enable the diagnosis of individuals with the white-coat syndrome.

1. Ambulatory blood pressure monitoring (ABPM): Blood pressure monitored by the 24-hour ABPM is currently the method utilized for diagnosing individuals with white-coat hypertension. The devices are light and use an oscillometric method for measuring the blood pressure and the heart rate for the whole day. The measurements include the initial reading, the mean pressure measurement in the first hour, the maximum values in the first hour, the final reading, the mean pressure in the last hour, and the maximum values in the last hour. Blood pressure values exceeding systolic pressure of 140 mm Hg and diastolic pressure of 90 mmHg, are diagnostic of the white-coat hypertensive effect. The threshold limit for ABPM is 135/85 mmHg. To avoid misdiagnosing patients with hypertension, a 24-hour-ABPM is recommended every 6 to 12 months. Patients with high office blood pressure but normal ABPM are diagnosed with white-coat hypertension. If the office blood pressure is normal while the ABPM is high, the individual has masked hypertension. The individuals with confirmed white-coat hypertension are prevented from consuming unnecessary hypertension drugs.

2. Self-measurement of blood pressure: The individuals with white-coat hypertension are recommended to measure their own blood pressure or in other words, self-measurement of blood pressure. Consistent values are obtained in the absence of white-coat hypertension. This enables the appropriate diagnosis of an individual regarding hypertension or the absence of it. During self-measurement, the individuals displaying a blood pressure >135/85 mmHg suffer from hypertension. Individuals are able to obtain blood pressure readings over a consistent period of time during the day. However, small variations in blood pressure or the records of blood pressure values during sleep cannot be measured with self-measurement as compared with ABPM. In addition, untreated individuals who measure their own blood pressure at home are at a slightly higher risk of cardiovascular disease compared to those who take antihypertensive drugs.

3. Deep-breath test: A study by a Japanese group observed that the individuals with white-coat hypertension, who take deep breaths, demonstrate a decrease in blood pressure. The test includes 5 deep breaths in a minute, while seated. A second study observed that the deep-breath test was just as capable of reducing the blood pressure of treated hypertensive individuals with the white-coat effect.

Advertisement

Treatment of White-coat Syndrome

White-coat syndrome does not pose a risk to individuals in the development of serious cardiovascular damage or other health conditions. There is no specific treatment of the individuals with the white–coat syndrome. Pharmacological treatment is not advised unless the patient displays hypertension. However, patients with the white-coat syndrome should be monitored for their blood pressure at regular intervals (eg, once a year). The office blood pressure as well as the self-measured blood pressure or the ABPM readings should be taken regularly. The chance of the patients progressing to hypertension increases with time and age. To avoid the situation, regular check-ups are advised. Other factors that need to be monitored are the regulation of glucose and lipid levels, the control of salt intake, the regulation of physical exercise, the modification of lifestyle, and avoiding smoking.

Preventing 'white Coat' Hypertension

Researchers at the University of Southampton say that docotors are not the best people to assess blood pressure. White coat hypertension is a well-known problem - it means that your blood pressure may go up when it's measured by a doctor (the 'white coat') but be lower if a practice nurse measures it, or if you measure it yourself. Researchers in, England, have been looking at the white coat effect in a group of 150 patients with high blood pressure (hypertension). Eight doctors and three practice nurses also took part in the study. More reliable readings were acquired when measurements were made by the nurses, or the patients themselves, at home. Doctors can prescribe or change medication, but they should not be the ones to take the blood pressure measurements if they want to make the right decisions on treatment.

How To Use A Blood Pressure Cuff At Home

There's a reason high blood pressure is called the "silent killer:" It generally produces no symptoms. "In other words, a person may feel perfectly fine yet have dangerously elevated blood pressures," says Ian Del Conde, M.D., a cardiologist and vascular medicine specialist at Baptist Health's Miami Cardiac & Vascular Institute in Florida. "The only way to know that one's blood pressure is normal is by measuring it."

High blood pressure is very common: According to the Centers for Disease Control and Prevention (CDC), nearly half of adults in the U.S. Have hypertension, and only one in four adults have it under control .

While your blood pressure is typically checked at routine doctor appointments, it may not give a complete picture.

"Blood pressure at the doctor's office is only one point in time," says Nieca Goldberg, M.D., medical director of NYU Women's Heart Program and senior advisor of Women's Health Strategy at NYU Langone Health in New York. "Some people have normal blood pressure at home and high blood pressure at the doctor's office or normal at the doctor's office and high blood pressure at home."

This variance can be explained as "white coat hypertension," the phenomenon of blood pressure rising at the doctor's office, or "masked hypertension," which occurs when your blood pressure is higher at home . Both situations are often stress-related, which is why it's important to check your blood pressure often—especially if you're at risk for hypertension, says Goldberg. Common risk factors for hypertension include physical inactivity, an unhealthy diet, obesity, diabetes, excessive alcohol consumption and tobacco use.

What Kind of Blood Pressure Cuff Should You Use?

Of the two types of at-home blood pressure cuffs—a wrist cuff and an upper arm cuff—experts generally recommend using an upper arm cuff because they are more accurate.

Experts also recommend opting for a digital blood pressure monitor over a manual one. "Automated electronic machines using an upper arm cuff are usually accurate," says Dr. Del Conde. "If there is any question about their accuracy, they can be validated against a blood pressure machine at a doctor's office."

Hospital-Grade Accuracy For Your Home

Oxiline blood pressure monitors enable you to view, store, and share all of your data with smartphone connectivity.

---