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Can doc's white coat raise blood pressure?


One of the reasons doctors stopped wearing white coats is that the sight of them can scare patients rigid and that has an effect not just on their emotions but also on their bodies.

It's thought that up to a quarter of patients have a temporary increase in blood pressure while having their blood pressure measured by their doctor.

So a doctor can think a patient has high blood pressure when it would be within a healthy range outside the doctor's surgery. This white coat effect can also make a person's high blood pressure appear worse than it is.

I've experienced the white coat syndrome myself.

When I had high blood pressure and had it taken by a doctor (not even in a white coat) my blood pressure was invariably higher than it had been only an hour before at home.

White coat hypertension is when a patient has persistently high blood pressure when a doctor's present but a normal one (below 135/85mmHg) when read at home.

While the effect has been mooted since the 1940s, it's generally poorly understood. For example, NICE says it's unclear whether the benefits of treatment differ in people with or without white coat hypertension.

As a result of my raised blood pressure whenever my doctor measured it I had to have continuous blood pressure monitoring for 24 hours.

So one new recommendation is that a diagnosis of high blood pressure should be checked with a 24-hour ambulatory blood pressure monitoring (ABPM). This means you wear a type of mobile blood pressure monitor that records numerous measurements throughout the day and night. NICE says the move will be better than simply relying on measurements in a clinical setting, and will help avoid the white coat effect.

The new proposals include lending patients this monitor device to be worn at home for 24 hours to confirm blood pressure, using revised criteria to decide when a patient should be given medication. What the 24-hour monitoring does is to allow your doctor to take an average of all your readings for a day and a night. That's a much better guide than a single reading.

Home monitoring is designed to bypass the "white coat effect". NICE is looking at treatment of special groups, such as people aged over 80 and people with high blood pressure that has been resistant to medication.

If you are at all worried your blood has been read incorrectly, don't stop taking your medication.

And if you have any concerns about your medication or the white coat effect, your GP can give you advice.

The sight of them scares patients rigid
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Title Annotation:Features; Opinion Column
Publication:The Mirror (London, England)
Date:May 30, 2014
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