White Coat Syndrome (White Coat Hypertension)

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What is White Coat Syndrome?

White coat syndrome, also called white coat hypertension, is a condition where a person experiences his blood pressure surpassing the normal range whenever in a medical setting.

The term was coined by Thomas Pickering after the white coats traditionally donned by doctors, with the condition being more prevalent in women and older adults. An opposite condition called ‘masked hypertension’ also exists where the blood pressure of a person is much lower at a clinic in comparison to readings at home.

White Coat Hypertension: Signs and Symptoms

Psychological symptoms involve:

  • Uneasiness and irritability
  • Overexcitement due to anger or fear

Physical symptoms include:

  • Fast heart rate
  • Shortness of breath
  • Excessive sweating suggesting anxiety
young female doctor, White Coat Syndrome
young female doctor holding a glasses behind abstract background

What Causes the White Coat Syndrome

The causes are stress, nervousness, and fear of the doctor while waiting at the doctor’s chamber, dentist’s office, or before surgery.

White Coat Syndrome: Diagnosis and Tests

Blood pressure is measured at regular intervals using regular BP monitors or by a noninvasive instrument known as a sphygmomanometer. The breathing pattern may be noted to detect any irregularities.

Urine tests as echocardiography and microalbuminuria may be conducted to look for end-organ damage.

Differential Diagnosis

  • Anxiety disorders
  • Sleep Apnea
  • Heart failure
  • Hyperthyroidism
  • Hemorrhagic stroke
  • Ischemic stroke
  • Myocardial Infarction
  • Heart murmur

Treatment and Management to Get Over White Coat Syndrome

White coat syndrome does not largely contribute towards any long term complication or organ damage as compared to sustained hypertension. So, the treatment mostly involves dealing with the symptoms through:

Exercises: Mild exercises along with aerobics for at least 30 minutes, three to five days a week, can help manage body weight as well as the insulin levels. Relaxation techniques like meditation, yoga or self hypnosis can also be adopted.

Diet Changes: Salt consumption should be limited and food items such as bread, pasta and rice should be avoided.

Lifestyle changes: Smoking and drinking should be avoided to prevent blood pressure rise.

Medical treatment

A 24-hour blood pressure monitoring is done using an oscillometric BP devise or a sphygmomanometer. In some cases, you may need to wear a small digital monitor which automatically checks the blood pressure day and night. Your doctor may also advise you to go for an annual follow-up.

Prognosis

White coat syndrome has a better prognosis as compared to sustained hypertension. With regular monitoring of blood pressure, the patient can overcome the syndrome.

medicine, health care , hypertension, White Coat Syndrome
close up of doctor and woman measuring blood pressure at hospital

Complications

Studies have shown that people having the white coat hypertension are at risk of developing true hypertension, unless the problem is controlled in time. It is also associated with higher chances of diabetes, elevated lipid levels, as well as cardiovascular risks such as a heart attack, stroke or even organ damage.

Having white coat syndrome in pregnancy may advance into gestational hypertension, cholestasis (a liver disorder characterized by severe itching, especially in hands and feet), progressive eczema and preeclampsia.

Incidence

It is a rather common syndrome, said to affect about 25% of the total population.

White coat syndrome ICD- 9 CM and ICD- 10 codes

The ICD-9-CM code of white coat syndrome is 796.2, and ICD-10-CM code is R03.0

References:

  1. http://www.bloodpressureuk.org
  2. http://www.webmd.com
  3. http://www.medscape.com
  4. http://www.mayoclinic.org

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