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Family Medicine (Expert Forum)
White Coat?
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
White Coat?
by Bushkey, Nov 28, 2001 12:00AM
My blood pressure is driving me crazy. When I go to the Dr. my blood pressure is 180/90 or more... I take Diovan 80mg. 1x daily and Lopressor50mg 2xdaily. At home my BP is as low as 90/50... I have compared my machine with the Dr. office... it is exactly the same.. which means at home is correct. Is this dangerous when it goes so high at his office and so low at home... what can I do to prevent this anxiety at the office... thank you so much for your time.
Doctor's Answer
by Forum-M.D.-DT, Nov 29, 2001 12:00AM
Thank you for visiting the Family Practice Forum.
Well, you hit the nail on the head when you put "white coat?" in the subject heading of this question.
After 10 years in clinical practice treating patients it is my personal opinion that the physicians office is likely the worst place to take a blood pressure reading. You drive to the office, wait in the waiting room, are taken to the examination room where your blood pressure is taken ... then wait for the doctor ... who may take you blood pressure again. This is not your "normal" daily routine. I suspect the blood pressure readings at home are likely a more accurate measure of what your actual blood pressure is on a daily basis.
You have already taken the first step, that is you have checked your home blood pressure machine with the BP readings found at the office. In my opinion, home blood pressure cuffs/machines are VERY ACCURATE, as are the machines available at many pharmacies. ( the exception is the blood pressure devices which are only connected to your finger ... these are more inaccurate). If you have a cuff that goes around your upper arm, like the cuff used at the doctors office, and you have found that comparison of the readings from your machine with the reading taken by the doctor/nurse at the office are similar, I would trust what your home device is telling you.
That being said, here is what I recommend to patients. Check your blood pressure once a day at home. Alternate the times you check it. For example Monday AM, Tuesday at noon, Wednesday at dinner time, Thursday at bedtime, etc. Do this for a month and bring these readings to the doctor. In my clinic, in patients with hypertension who seem to have very high readings in the office, I use the home measurements to make medication adjustments. STRESS ... increases your blood pressure. I suspect that the stress of going to the doctor along with the stress of worrying that once again your readings will be higher that you are seeing at home ... are causing your BP to go up. My feeling based on what you are telling me is that the medication is working very well, in fact, you may be on more medication that you may actually need. A BP of 180/90 is high, but not what I would consider "dangerous". I suspect this high reading is due to the stress involved with going to the doctor's office. In fact, this is one of the reasons I have started my own website (NetLiveMD.com). We do chronic disease monitoring including hypertension monitoring from the home. As I mention, I have found that BP readings taken at home (as long as the home BP measuring device has been checked against actual BPs taken at the doctors office) provide a convenient and cost effective way to monitor chronic diseases such as hypertension.
Some advice to help you control BP at the doctor's office.
1. Bring your home BP measurements
2. Arrive early
3. Bring some relaxing music with you (i.e. with a "walkman")
4. If you are a smoker ... don't smoke, and don't smoke within 2 hours of your visit to the doctor
5. Avoid any caffeine the day you are going to the doctor.
Let me know if I can be of any further assistance. Again, I really am a big advocate of treatment of hypertension based on home BP measurements. Your case is a classic example of how "white coat hypertension" can make for a confusing and difficult problem in the treatment of hypertension.
Dean M. Tomasello, M.D.
Well, you hit the nail on the head when you put "white coat?" in the subject heading of this question.
After 10 years in clinical practice treating patients it is my personal opinion that the physicians office is likely the worst place to take a blood pressure reading. You drive to the office, wait in the waiting room, are taken to the examination room where your blood pressure is taken ... then wait for the doctor ... who may take you blood pressure again. This is not your "normal" daily routine. I suspect the blood pressure readings at home are likely a more accurate measure of what your actual blood pressure is on a daily basis.
You have already taken the first step, that is you have checked your home blood pressure machine with the BP readings found at the office. In my opinion, home blood pressure cuffs/machines are VERY ACCURATE, as are the machines available at many pharmacies. ( the exception is the blood pressure devices which are only connected to your finger ... these are more inaccurate). If you have a cuff that goes around your upper arm, like the cuff used at the doctors office, and you have found that comparison of the readings from your machine with the reading taken by the doctor/nurse at the office are similar, I would trust what your home device is telling you.
That being said, here is what I recommend to patients. Check your blood pressure once a day at home. Alternate the times you check it. For example Monday AM, Tuesday at noon, Wednesday at dinner time, Thursday at bedtime, etc. Do this for a month and bring these readings to the doctor. In my clinic, in patients with hypertension who seem to have very high readings in the office, I use the home measurements to make medication adjustments. STRESS ... increases your blood pressure. I suspect that the stress of going to the doctor along with the stress of worrying that once again your readings will be higher that you are seeing at home ... are causing your BP to go up. My feeling based on what you are telling me is that the medication is working very well, in fact, you may be on more medication that you may actually need. A BP of 180/90 is high, but not what I would consider "dangerous". I suspect this high reading is due to the stress involved with going to the doctor's office. In fact, this is one of the reasons I have started my own website (NetLiveMD.com). We do chronic disease monitoring including hypertension monitoring from the home. As I mention, I have found that BP readings taken at home (as long as the home BP measuring device has been checked against actual BPs taken at the doctors office) provide a convenient and cost effective way to monitor chronic diseases such as hypertension.
Some advice to help you control BP at the doctor's office.
1. Bring your home BP measurements
2. Arrive early
3. Bring some relaxing music with you (i.e. with a "walkman")
4. If you are a smoker ... don't smoke, and don't smoke within 2 hours of your visit to the doctor
5. Avoid any caffeine the day you are going to the doctor.
Let me know if I can be of any further assistance. Again, I really am a big advocate of treatment of hypertension based on home BP measurements. Your case is a classic example of how "white coat hypertension" can make for a confusing and difficult problem in the treatment of hypertension.
Dean M. Tomasello, M.D.
Member Comments
by Bushkey, Nov 30, 2001 12:00AM
Dr. T - Thank you so much for your feedback. I feel more confident with my situation now.
