Is white coat hypertension really dangerous?

I'm considering posting this in the expert forum, but I want your opinion first.

First: about me:
Male, 29, 188 cm, 85 kg. Eating healthy. Cholesterol 4,5 mmol/l (165 mg/dl). Exercise 90 minutes 3x/week, where 45 min is cardio and 45 min is weightlifting. Non smoker, no alcohol, no illegal drugs. Meds: 12,5 mg metoprolol/day for PACs. Resting heart rate 50. Max heart rate 210. Excellent cardiac function with LVEF 75-80%. Max exercise tolerance 14-15 METs. Normal EKG.

My problem the last months is intense anxiety while measuring blood pressure, which occationally increases the BP to 150-160 systolic / 90-100 diastolic.

It seems I've finally realized that my BP monitor won't bite me, and yesterday my results were:

Supine: 108/60 mmHg - HR 57
Sitting: 106/65 mmHg - HR 62
Standing: 104/75 mmHg - HR 73

Much to my surprise, the cardiologist at the expert forum recommended me to ask for HCTZ to lower my blood pressure, because it's not healthy to have BP in the 160s. I understand that. I told my PCP and he started laughing. He is more concerned that my BP is occationally far too low. My heart rate dips at night (to 35-40) and he believes my BP does the same.

Sometimes I get dizzy while standing up (especially after exercise) and honestly I don't want any lower BP. But I know that I'm stressed from time to time, and my BP is probably higher than 108/60, possibly above 140.

My cardiologist told me that white coat hypertension is normal and should NOT be treated. But the skilled doctors at Cleveland Clinic think otherwise. Who is right?

[itdood]

When I had "white coat syndrome", at my worst I'd get 130-140/80-90.  My doc wanted to treat.  the new guidelines in America are to treat white coat syndrome and borderline.  

Some docs would take your word for it if you did two things  1)  bring your home BP machine in to make sure it's accurate and 2) keep a log and bring it to the office.   If you met both these criteria and the log was clean, the doc would not prescribe BP meds.

If you didn't take these steps AND refused meds you will be marked AMA on your file (against medical advise).  At your age this is something you do not want on file.  Good luck getting a cheap rate on life insurance down the road....  It's in your best interest to have a clean file.

For whatever reason I don't have white coat syndrome anymore and I'm normal to below normal in the doc's office.  I elected to not treat years ago but I did have my machine checked and logged my BP regularly.  I'm glad I didn't treat because whatever the issue was it resolved on its own.

For you it's a tougher question.  Your 150-160 / 90-100 is higher than mine was.  The only time I get that high is as stage 4 on a stress test.  Even at my most anxious I would not get that high.

My recommendation is to see if you can take the home monitoring approach and come up with a strategy to control the anxiety issue.  Meds are a last resort in my humble opinion.

[itdood]

When I had "white coat syndrome", at my worst I'd get 130-140/80-90.  My doc wanted to treat.  the new guidelines in America are to treat white coat syndrome and borderline.  

Some docs would take your word for it if you did two things  1)  bring your home BP machine in to make sure it's accurate and 2) keep a log and bring it to the office.   If you met both these criteria and the log was clean, the doc would not prescribe BP meds.

If you didn't take these steps AND refused meds you will be marked AMA on your file (against medical advise).  At your age this is something you do not want on file.  Good luck getting a cheap rate on life insurance down the road....  It's in your best interest to have a clean file.

For whatever reason I don't have white coat syndrome anymore and I'm normal to below normal in the doc's office.  I elected to not treat years ago but I did have my machine checked and logged my BP regularly.  I'm glad I didn't treat because whatever the issue was it resolved on its own.

For you it's a tougher question.  Your 150-160 / 90-100 is higher than mine was.  The only time I get that high is as stage 4 on a stress test.  Even at my most anxious I would not get that high.

My recommendation is to see if you can take the home monitoring approach and come up with a strategy to control the anxiety issue.  Meds are a last resort in my humble opinion.