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Ask the Medical Expert Archives 2000-2004

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White Coat Hypertension
May 2000

Q. My blood pressure is always higher in my doctors office than when my sister checks it (who is a nurse). I am on two medications for blood pressure already. Should I be concerned?

A. You likely have what is termed "white coat hypertension". There are several patients who have a similar situation to yours where their blood pressure taken in the office is usually significantly higher than when done at home. Many patients do get nervous at the Doctors office which can increase adrenaline levels which can elevate blood pressure and heart rate. What I recommend to any patient that I think may fit this scenario is that they get a home automated blood pressure(bp) cuff such as an Omron (which makes a good quality cuff that is battery operated and gives both bp and heart rate read outs), and check the home bp and heart rate once per week and write them down.

I then see the patient back in the office and review these readings and also check their home bp monitor for accuracy by comparing it to my bp reading at the time of office visit (both readings at that time will likely be elevated, but should be similar). If the monitor is accurate, and the patient has normal bp readings at home, then I would not recommend increasing bp meds just because of the elevated office bp. Normal bp is considered less than 130/85, although ideal blood pressure is less than or equal to 120/80.

For more info: American Heart Association 1-800-242-8721

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