Getting accurate blood pressure readings depends on doctors understanding patient anxiety and 'white coat syndrome'

PHILADELPHIA (KYW Newsradio) — In their weekly conversation, KYW's Michelle Durham brings a question to KYW Medical Editor Dr. Brian McDonough from listener J.Z. about the phenomenon called “white coat syndrome.”

Michelle Durham: This is so interesting. I've always wanted to discuss this with you: white coat syndrome.

Dr. Brian: “ White coat syndrome” is the name for a situation when a patient comes in and they say, ‘My blood pressure is fine at home, but I get to the doctor's office, and my blood pressure is up.’ And the response is something like, ‘You must be afraid of the doctor. You have white coat syndrome.’

It’s something we've talked about for years. And we've done things to try to help — which is, you tell people to sit down for about five minutes, calm down. I mean, somebody comes in, they're in the waiting room, they're doing a copay, they've gotten off a bus, their pressure is going to be up — so, you try to reduce it.

So, you get them to calm down and make sure they've gone to the bathroom, feet on the floor, they're not talking while they're in the office. All those things help, and sometimes that lowers the pressure, but in many cases, the patient says, ‘I've been taking it at home, and it's so much lower at home.’ And what we've done in medicine now, the American Medical Association and all the other groups that regulate things are now saying: ‘Why are we not doing more ambulatory blood pressure monitoring?’

In other words, let's look at people taking their pressure at home and use those things as maybe more reliable than when they come to the office. So what we're trying to do is recognize there is this white coat syndrome — whether it's from stress or whether it's from being scared of the doctor, or whatever it is — and take advantage of the technology available now, so people can do things at home. That's really the approach we're taking.

There's a spin-off of this that I think is really important to talk about, and that is ‘masked hypertension.’ People who take short-acting blood pressure medicines, they come to the office and their pressure is fine, it's good, but later on in the day because the medicine wears off (they take it once a day, or whatever), their pressure goes up later. And we're not picking it up at the office. So one of the things you want to do is talk with your doctor about the medicines you're on and see how long they work, because it's okay. And it's important to be controlled during the day. But you don't want to lose that when at night or later on in the day.

I've always wanted to ask this question to a physician: Do you ever get offended?

No, I'm not really. I think we know that, you put people in a unique environment. You know, we're in the office all day. We're seeing patients. So for us, it's the routine. But the reality for patients is, when you go to a doctor's office, you're totally out of your routine. And in many cases, you're discussing things that are very personal, or things you're frightened about, or issues you may not want to talk about — and it's natural for that to happen.

And finally, it's tough — depending where the doctor's office is located. Sometimes it's tough to get in. It's a lot of work to get in there, especially taking public transportation. Or you're trying to find a place to park. It can be stressful.

People are emailing us questions left and right, and we are delighted. You can, too, at AskDrBrian@kywnewsradio.com .