White-coat hypertension

[NBCT]

Would you be able to clarify the significance(if any) of the so called white coat hypertension term. I recently had a routine gyn appt. and my BP was elevated 160/90. At rest or with no added nervous energy I run 100/60 or less. I told the MD I was taking Toprol Xl daily for MVPS and that I was not concerned with  a BP that I know will return to baseline as soon as I leave the office. She then proceeded to lecture me(after circling the reading on my chart a few times) the new findings that it can be just as dangerous and should not be taken lightly. I listened and respected her concern since I am a nurse and know informing a patient is part of her practice. I remember hearing news briefs on this, but never viewed any footage. I have been in nursing for 20 years and have seen many admittedly nervous patients with high BP's.
I would appreciate any input or information you may have regarding this. Thank you.

[TimL]

I have been on medication for HBP for the past seven years and still suffer a mild white coat effect when my doctor takes my BP.  (Thankfully it remains in the normal range). I invested in a decent BP monitor - the same make and model as my doctor's, had it checked by him - mainly so I could monitor the effect of lifestyle changes on my BP but also as a means of checking any such white coat effect.  

Relying on a doctor's reading every few months is not enough if you want to guage the effect of changes in lifestyle, diet, stress, etc. on BP. These days the doctor relies as much on my daily monitoring as his once a quarter readings.

[hbp702]

Watch that blood sugar. By mildly elevated, do you mean impaired fasting glucose (110-125), impaired glucose tolerance (2 hour BG >= 140 and <199) or mild diabetes (FBG 126 and up and/or 2 hour BG >=200)?

Even "mild" diabetes will cause severe damage given enough time, and already indicates significant pancreas damage (basically one has beta cell failure - insulin resistance alone doesn't cause diabetes - until the pancreas gets damaged from overwork).

Someone I knew got early onset type 2 diabetes (which is now an epidemic in and of itself) and it ws "mild" and "under control", but she still had an infection that wouldn't go away for months even with treatment, whereas a healthy person would have overcome it in less than a month tops.

Complication of diabetes strike harder, sooner, and more often these days, the disease itself has gotten worse.

If it is just IFG or IGT, you can likely reverse it but you are  at great risk of diabetes.

There are many other drugs than diuretics to treat HBP. You obviously are not tolerating it. Get your doctor to take you off it ASAP and get you on something you can tolerate. Diuretics cause diabetes, gout, high cholesterol and bothersome side effects. Their big advantage is they are cheap, doctors/insurance companies like that.

Given your problems I wouldn't take a beta blocker either (they can cause diabetes too). Get your doctor to control your BP without diuretics or beta blockers.

Before it's too late.

[Ianna]

Hi Utbc,

You hit the nail on the head.
-Very well said-
-
Good luck - ***Ianna***

[Mel22]

Hi There!

Interesting that your pressure *rose* after taking a diuretic! How did they explain that?

[usedtobecatchy]

The bp meds immediately lowered my bp to normal, but it also, immediately, though mildly, elevated my blood sugar. For three years all was stable. Then I added an allergy drug to the mix-and the bp rose. When I added ibuprofen to the mix bp rose even more. Now my bp med has been doubled and I am back to normal bp, which probably means a slight increase in blood sugar to look forward to :-)
Now if someone could explain why my high carbon dioxide levels dropped to low normal?

[Crow]

I take 80mg of Demadex every day.  Why is my blood pressure still 100/60?

[usedtobecatchy]

I have had hbp diagnosed for 15yrs. I am on medication for it. I am female. The blood pressure the nurse took (120/82) was slightly lower than the blood pressure the doctor took, and there was the mumbled crack about "and of course its higher when I take it." There is alot of male to female/ego bias with "white coat syndrome." (I was quietly sitting for a period of time before nurse, and stand up sit down stand up sit down collect urine specimen stand up sit down climb up sit down shake hands before the dr...I won't even get into the skill levels of taking bp's.)

In my case I get the lecture about blood sugar and cholesterol and my "lack of concern" over it. I view it as my lack of hysteria over it-especially since the elevation is mild and has remained stable for years and only arose immediately upon starting a diuretic. Do I take it lightly? No-that's why I have it checked periodically.

[CCF-M.D.-RCJ]

NBCT,

Thanks for your question.

There has been some controversy surrounding this subject, but the most recent study (and I can't find it on a Sunday) found a correlation between "white coat hypertension" and increased events commonly seen with hypertension.

Nevertheless, the diagnosis of hypertension rests on repeated findings of elevated blood pressure, unless the person presents with stage 4 hypertension or hypertensive urgency.  I generally see a person at least twice before labeling them with that diagnosis; however, when I see someone in my clinic with blood pressure above 150/85, it usually means that they will have repeat measurements in the hypertension range.

An easy way for you to settle the manner would be to undergo ambulatory blood pressure monitoring.  As always, discuss the matter further with your doctor.

Hope that helps.