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How Is White Coat Hypertension Linked To Heart Disease? People may have higher blood pressure readings measured when they are at the clinic than at home. This is known as white coat effect or white coat syndrome. It happens because some people are nervous about having their blood pressure measured by a doctor or nurse in medical settings. The term white coat hypertension is used if a patient has high blood pressure readings that are persistently higher than 140/90mmHg in a medical setting while his or her blood pressure readings may be normal, which is around 120/80 mmHg, when taken at home. This can pose difficulty for doctors who cannot establish whether the patient actually have high blood pressure or are just experiencing white coat hypertension. White coat hypertension, according to health experts, is triggered by the release of stress-related hormones like adrenaline, cortisol, epinephrine, and norepinephrine. These hormones work on the sympathetic nervous system and instigate the so-called fight or flight response. An elevated blood pressure happens to be one of the side effects. The difference between these two is that white coat hypertension is reserved for those who are not receiving antihypertensive drug therapy. White coat effect, on the other hand, is a very common response for visiting medical setting, and it is observed in most hypertensive patients as an elevated office blood pressure with a lower home blood pressure. White coat effect tends to be most apparent with the initial blood pressure measurement. Anyone can be affected by the white coat effect, but white coat hypertension is less common.
Although white coat hypertension was traditionally
considered a transient and largely harmless, recent research suggests that this
may not be the case. Some doctors suspect white coat hypertension could be a
warning sign of real hypertension. There were studies linked white coat
hypertension to an increased risk of stroke, heart attack, heart failure and
other cardiovascular conditions, as well as death from heart disease.
For instance, researchers from China reported in their findings published April 2017 in ‘Journal of Hypertension’ that white coat hypertension is associated to long-term risk of cardiovascular disease and total mortality in patients without antihypertensive treatment. They urged doctors to perform close follow-up patients in patients with white coat hypertension. In another study published April 18, 2018 in the ‘New England Journal of Medicine’, researchers from the Autonomous University of Madrid found that the risk of death was nearly twice as high for patients with white coat hypertension, compared to patients whose blood pressure is normal when taken at the doctor's office and at home after following 63,910 adults over 5 years. They also concluded that blood pressure measurements taken at home regularly were a stronger predictor of cardiovascular deaths than doctor's office readings. But not all patients with white coat hypertension are at higher cardiovascular risk. According to a study published online November 8, 2016 in ‘Journal of the American College of Cardiology’, white coat hypertension was only linked to elevated risk for heart events in older patients with high cardiovascular risk. High-risk participants with white coat hypertension over the age of 60 had more than 2 times greater risk for heart events than those with low risk. There was, however, no significant difference in risk for heart events among low-risk participants with and without white coat hypertension. High cardiovascular risk was defined as having diabetes, prior heart events or at least 3 other risk factors, such as high cholesterol, obesity and smoking. Meanwhile, other research also found that people with white coat hypertension may often experience elevated blood pressure during their sleep. Blood pressure is expected to dip at night during sleep but for some reason, this does not the cause for those with white coat hypertension. The abnormal hikes in blood pressure may also suggest an untreated anxiety disorder that is known to raise heart attack risk. One such example is social anxiety disorder, a condition in which a person may need to overcome with anxiety when out of the home but may be fine at home.
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