white coat syndrome

White Coat Syndrome: What Is It, and How Bad Is It?

So, have you recently purchased a digital blood pressure monitor? It’s a step in the right direction because doctors highly recommend monitoring blood pressure at home. For optimal results, it’s essential to check your blood pressure multiple times in the morning when your body is relatively at rest and in the evening after a hectic day.

However, blood pressure monitoring is not as straightforward as it may seem. While digital blood pressure monitors are relatively simple to use, their readings can fluctuate throughout the day. This can be confusing and raise many questions, especially when considering that one-third of the population in India has hypertension. Shockingly, even one-fifth of young adults in India are living with hypertension.

If you obtain different readings during the day, remember that the highest one is the correct reading. This means that if you measure 110/80 mmHg in the morning and 140/90 mmHg in the evening, the latter reading is accurate, indicating hypertension that requires management.

But what if a person is not living with hypertension? Is there a need to monitor blood pressure at home? Yes, even if a person doesn’t have hypertension, monitoring blood pressure is advisable, especially for individuals above the age of 30. High blood pressure, or hypertension, significantly increases the risk of heart attacks, strokes, kidney disease, and more.

What Is White Coat Syndrome?

So, what if a doctor finds that your blood pressure is elevated, and you weren’t aware of it? Well, it’s most likely a case of hypertension or high blood pressure, but not necessarily. It’s still a good practice to take multiple readings before drawing any conclusions or starting medical treatment.

Sometimes, blood pressure can increase when visiting a doctor due to anxiety and tension. Some individuals are more prone to this condition. However, readings tend to be relatively normal when they monitor their blood pressure at home. This type of elevated blood pressure, caused by fear and anxiety when visiting a doctor, is known as “White Coat Syndrome.”

Is this a common condition, and how do doctors diagnose it? Yes, it’s quite a common condition. A study published in the Journal of the American Heart Association found that this issue affects 15-30% of the population, making it a very common problem.

Therefore, the American Heart Association and the British National Institute for Health and Clinical Excellence (NICE) recommend that everyone should monitor their blood pressure at home before drawing any conclusions.

For example, if your blood pressure measures above 140/90 mmHg when tested in a clinic or doctor’s office but consistently shows readings below 140/90 mmHg when measured at home, this may indicate white coat syndrome. However, a diagnosis of white coat syndrome is typically made only if such a discrepancy is observed on three separate occasions.

This underscores the importance of monitoring your blood pressure while in a relaxed home environment. It’s crucial to understand that a reliable digital blood pressure monitoring device is an essential tool that every household should have.

White Coat Syndrome May Pose Health Risks

White coat syndrome is not entirely benign, as previously believed. It’s worth noting that white coat syndrome suggests an increased risk of developing high blood pressure in the future. After all, this condition occurs in individuals who are prone to high blood pressure during periods of stress.

So, even if your blood pressure appears normal when measured at home but spikes when measured in a clinic, it’s a reason to monitor your blood pressure regularly. White coat syndrome remains a red flag, indicating that the person is at a considerable risk of developing hypertension. Such individuals, even if they have normal blood pressure at other times, are often borderline.

Furthermore, it’s essential to understand that doctors only confirm white coat syndrome when no other signs of heart disease are present.

Studies also indicate that those prone to white coat syndrome may have some issues that make them susceptible to hypertension and even heart disease. These studies suggest that in these individuals, the heart muscles (left ventricle) may not relax adequately during periods of stress.

How to Overcome White Coat Syndrome?

White coat syndrome presents several challenges, with the most significant being diagnostic issues. Doctors tend to rely more on blood pressure readings taken in their offices, which can sometimes lead to unnecessary initiation of drug therapy.

There are several ways to overcome white coat syndrome. If you’ve experienced this issue and found that your blood pressure was lower when checked at home, consider measures such as anxiety management, exercise, dietary changes (like reducing salt intake), and improving sleep. Additionally, try to schedule your doctor’s visits in the first half of the day. Visiting a regular family physician may also help reduce stress and anxiety, as you’re more likely to feel comfortable in such a setting compared to a multi-specialty hospital.


In theory, white coat syndrome is not a disease but rather a psychological issue. Therefore, it does not necessitate anti-hypertensive drugs for management. Instead, focus on lifestyle interventions that reduce stress and help manage blood pressure, such as exercise, meditation, and a low-sodium diet.

However, it’s essential to understand that attitudes toward white coat syndrome have evolved in recent years, with some studies suggesting that it still affects hemodynamics and is associated with a higher risk of heart disease.

A doctor may consider initiating treatment for white coat syndrome, even if the blood pressure is only slightly above 135/85 mmHg, as this could still suggest an early stage of hypertension.

In Conclusion

White coat syndrome is not true hypertension. It’s an increase in blood pressure caused by stress and anxiety when visiting a doctor. Nevertheless, individuals living with this condition are at an elevated risk of developing hypertension or heart disease in the future. Therefore, it’s crucial for them to regularly monitor their blood pressure at home and implement lifestyle interventions such as dietary changes, exercise, and stress management.

Published by

Dr. Preet Pal Singh Bhinder

Preet Pal Singh Bhinder is a physician (M.D. Medicine) with specialization in diabetes (Fellowship in diabetes, Royal Liverpool Academy). His professional experience is divided into medical practice and working at higher management for pharmaceutical multinational companies at various international destinations. Also has been involved in clinical trials of numerous drugs, food supplements, and vaccines.

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