White Coat Hypertension

  Is there such a thing?  Every time I get into *most* doctors offices, my BP is high.  Then in others it is normal.  Today, I saw a doctor and he mentioned that I have White Coat Hypertension as my BP after talking to him for 15 minutes and being anxious was 160/94.       A half hour later he took it again.    It was 130/88..He said I really needed to be on B.P. Meds as I would go to an early grave as this could be happening at home with stress etc.  I am not under stress but who knows.  He is concerned by the bottom number and since I am in almost constant pain of some sort he thinks the constant pain can contribute also. he said the bottom number should always be under 85.   He told me to buy a BP Monitor with a digital read out and automatic.   He mentioned taking it with activity and stress and excitement and quiet times.  He is treating me for bronchial problems and said I have to be on a BP med that does not interfer with the breathing asperatus.  He mentioned dyazide first.  Doctor, can one lower this without medication?  This doctor said that the bottom number if over 85 can do damage to the heart.   Thank You for any information.    Anne  P.S. I am 51 yrs. old.

[CCF Cardio MD - MTR]

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Dear Anne, thank you for your question.  Hypertension can certainly be hard to
evaluate since many patients have an increase in blood pressure when they
see a doctor (white coat hypertension).  New guidelines recommend that the blood
pressure be consistently below 130/85.  Long-term effects from high-blood pressure
take 10-20 years to develop and usually occur at BP's higher than 130/85.  However,
physicians take an aggressive approach to hypertension because it can be treated
with medications that have few side effects and treatment can prevent complications
from occuring in the future.  I can't say that you'll face an early death with
the blood pressure readings you describe because noone can predict the future.
I agree with your doctor that you should purchase a home BP monitor and check
your BP 2-3 times/week at home and record the readings you obtain.  Then, when
you visit your physician, bring in your logbook to show him multiple readings of
the BP.  Only with this information, can doctors make informed decisions about
treating hypertension.   Hypertension can be treated with avoidance of salt in
the diet, losing weight, and exercising.  However, in some patients, these
maneuvers do not adequately treat hypertension and medications are needed.  
Medications that are usually used first in patients with hypertension are beta
blockers and diuretics.  Beta blockers can aggravate asthma so they are generally
avoided in patients with asthma.  Diuretics are well-tolerated and dyazide is
a typical diuretic that would be used.  Other medications that can be used if
beta blockers and diuretics aren't successful are ACE inhibitors and calcium
channel blockers.  I think you should talk with your physician about whether
you can try weight loss, exercise, and salt reduction as a first line step
for treating your BP and then medications if the BP remains high.  But, you
must remember that hypertension needs to be treated aggressively and that
you should closely monitor your BP at home.  Finally, better treatment of your
chronic pain may help to control your BP.  I hope you find this information
useful.  
Information provided in the heart forum is for general purposes only.  Specific
diagnoses and therapies can only be provided by your physician.