Updated 07 July 2014

White coat hypertension

White coat hypertension = anxiety-induced hypertension.

There are two major types of hypertension and four more not so common types, including White Coat Hypertension.

White coat hypertension

Also called anxiety-induced hypertension, it means blood pressure is only high when tested by a health professional.  If confirmed, with repeat readings outside of the clinical setting, or a 24-hour monitoring device, it does not need to be treated.  However, regular follow-up is recommended to ensure that persistent hypertension has not developed.

Lifestyle changes like exercise, a reduction in salt and alcohol intake, stopping smoking and losing weight, would be wise.  A low fat, high fibre diet, with increased fruit and vegetable intake, will be beneficial.

Who gets it?

It is very common in all patients, but slightly more so in women. Those older than 65 years are also more prone, due to age-related stiffening of the arteries. This condition, called arteriosclerosis, is a result of the western lifestyle and diet.

Patients with white coat hypertension do not necessarily look nervous, and are not neurotic. In fact, most look deceptively calm during the doctor's visit. Many people have white coat hypertension even after long and friendly relations with their doctor.

Make sure that it’s only white coat hypertension

Never assume that your blood pressure is raised merely because the sight and smell of a clinic makes you feel apprehensive. It is important to make sure that you do not actually have hypertension.

Your doctor will do repeat measurements, and if still high, and white coat hypertension is suspected by him or her, he or she may recommend that readings be taken outside of the clinical setting. These might be regular readings at home or even 24 hour monitoring, a device that typically takes a reading every 15 minutes as you go about your normal activities. The latter would be especially applicable where risk factors or co-existing diseases are present.

I have white coat hypertension - what now?

Treatment of white coat hypertension is regarded as unnecessary, especially in the elderly. However, regular follow-up is recommended to determine if persistent hypertension has not developed, as there seems to be an increased likelihood in some patients.

It would also be wise to consider the lifestyle modifications specified elsewhere on this site, as a proactive approach to managing your health risks.

(Reviewed: Dr Kathleen Coetzee, MB ChB)

Read more:
Hypertension and your weight


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Dr Jacomien de Villiers qualified as a specialist physician at the University of Pretoria in 1995. She worked at various clinics at the Department of Internal Medicine, Steve Biko Hospital, these include General Internal Medicine, Hypertension, Diabetes and Cardiology. She has run a private practice since 2001, as well as a consultant post at the Endocrine Clinic of Steve Biko Hospital.

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