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White Coat Syndrome?
Old 12-10-2008, 09:29 PM   #1
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White Coat Syndrome?

About a month ago I went to my regular doctor for a check up. The nurse took my BP and it was up, 149/xx ( don't remember the lower value). About twenty minutes later the Doctor checked it again and it was down to 136/xx. Last week I was at the dentist office and they checked my BP and again it was up, 148/xx. Yesterday I was at another dentist to see about having a wisdom tooth pulled and they checked my BP and it was up to 164/xx. Yikes.

When I got home I pulled out our portable BP monitor and checked it. Much lower at 136/82. This morning I checked it and it was 128/78 which is about what it has been running the last few years. I know the my BP gizmo is accurate because DW had her doctor check it against his a few months ago.

My only conclusion is the White Coat Syndrome. They're coming to take me away.

Anyone else ever have this come up?
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Old 12-10-2008, 11:05 PM   #2
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I have a good friend who has this problem, too. His BP does not go down in the Dr's office though after a while.
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Old 12-11-2008, 12:04 AM   #3
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Yes, I have it. Significant.
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Old 12-11-2008, 07:22 AM   #4
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Since the nurse takes mine, I call it the White Dress Syndrome.
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Old 12-11-2008, 07:54 AM   #5
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This is commonplace. Problem is, "labile hypertension" correlates with similar transient elevations during life's routine stressors -- late for an appt, spat with SO, idiot cuts you off on the highway. This exaggerated BP response to minor stress such as a doctor visit is associated with some increased risk for the usual longterm complications of hypertension, but not as much of a risk as there is with chronically elevated blood pressure. It's kind of an exaggerated fight-or-flight response.

While we know it is associated with some excess risk, we do not know if conventional treatment lowers that risk. What I do is assess it in the context of the patient's other risks: if they are lean, fit, have no other risk factors and have a good lifestyle I will often just follow closely and defer treatment until it really starts to rise higher or more consistently. OTOH, if the patient is a diabetic smoker with a family history of stroke and heart disease I will treat sooner and more aggressively. In between those extremes it's a judgment call.
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Old 12-11-2008, 08:10 AM   #6
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minor stress such as a doctor visit
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Old 12-11-2008, 08:24 AM   #7
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UncleHoney et al: if the decision is a close call, you can arrange for a 24 hour BP monitor to be worn during your normal daily routine. That should separate out those with rare elevations from those with frequent ones who stand to gain more from treatment.
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Old 12-11-2008, 08:50 AM   #8
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Not a bit. my doc and his staff are really wonderful people. i'm one of those lucky 120/60 something people, even when i was w*rking and totally stressed out. i think it was more relaxing to go to see the doc than the j*b. can we call it "Labile Hypotension" ?
i'll bet my BP goes up at the dentist though.
try this - if my GP doc is running late, i just stretch out on the exam table and take a nap. i put a paper towel over my eyes and use my coat as a pillow.
the first time i ever did this, i freaked out my doc. his schedule was running 45 minutes late. he entered the exam room and must have said hello. i was so soundly asleep, i didn't respond at first. when i woke up, he told me i said, go away, i'm trying to sleep here. we both had a good laugh.
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Old 12-11-2008, 08:51 AM   #9
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Originally Posted by Rich_in_Tampa View Post
This is commonplace. Problem is, "labile hypertension" correlates with similar transient elevations during life's routine stressors -- late for an appt, spat with SO, idiot cuts you off on the highway. This exaggerated BP response to minor stress such as a doctor visit is associated with some increased risk for the usual longterm complications of hypertension, but not as much of a risk as there is with chronically elevated blood pressure. It's kind of an exaggerated fight-or-flight response.

While we know it is associated with some excess risk, we do not know if conventional treatment lowers that risk. What I do is assess it in the context of the patient's other risks: if they are lean, fit, have no other risk factors and have a good lifestyle I will often just follow closely and defer treatment until it really starts to rise higher or more consistently. OTOH, if the patient is a diabetic smoker with a family history of stroke and heart disease I will treat sooner and more aggressively. In between those extremes it's a judgment call.
Thanks for the response Rich. I do have a tendency to get "steamed" easily when things are not going my way or something goes wrong and I can't do anything about it.

It's really interesting how your mental state effects how your body works. About 40 years ago when I was in the army I took part in some tests for training MP's on how to use a polygraph. Five of us actually pulled a prearranged robbery at a pizza shop on the post with a gun and and a get away car. I was the get-away car driver.

After all the tests I found out they could read me like a book with their little machine. They could even tell what color the car was just by looking at the polygraph. The final conclusion from the officer in charge was that I not try to lead a life of crime and if I ever did, don't ever take a lie detector test. He said, "You can't lie worth a hoot".

Maybe that's why I'm so risk adverse with respect to my very conservative investments.
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Old 12-11-2008, 11:47 AM   #10
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My mom has it. Her Dr. gave her a BP diary (that's what she calls it) that she is supposed to fill out by checking her BP at home twice a day and bring it in on her visit to the Dr.

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Old 12-11-2008, 03:14 PM   #11
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I had the White Coat Syndrome while w*rking (and fat). Interesting thing is, I can feel when my BP is high and rising and this upsets me and makes it go up even more(bad feedback loop).
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Old 12-11-2008, 05:27 PM   #12
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Since the nurse takes mine, I call it the White Dress Syndrome.
No. That's Big Knockers Syndrome.
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Old 12-11-2008, 06:16 PM   #13
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Originally Posted by freebird5825 View Post
Not a bit. my doc and his staff are really wonderful people. i'm one of those lucky 120/60 something people, even when i was w*rking and totally stressed out. i think it was more relaxing to go to see the doc than the j*b. can we call it "Labile Hypotension" ?
i'll bet my BP goes up at the dentist though.
Some people have "masked hypertension": their blood pressure is up everywhere but the doctor's office!

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Old 12-11-2008, 09:01 PM   #14
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My blood pressure and heart rate are always at low end of being alive.

Makes it a real pain to get blood drawn, it usually takes a couple veins and that doesn't agree too well with my trypanophobia.
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Old 12-12-2008, 01:18 PM   #15
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My only conclusion is the White Coat Syndrome. They're coming to take me away.

Anyone else ever have this come up?
I have sort of twist on white coat syndrome. Because I'm on "blood thinners," I get a blood test once a month. Because I do it so often, I'm quite comfortable doing it. While I'm there, they also take my BP. The last time I was there, my BP was 110/60. However, when I go to my GP or cardiologist, both of whom I'm less comfortable with, my BP is dramatically higher. The last time a doctor did it, it was in the 140/xxx range.
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Old 12-14-2008, 09:15 AM   #16
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I have this quite often. Pressure treated at docs office is about 135/90 on average, sometimes highers, sometimes lower.

At home, with 2 machines and one stethesope gauge, which I listen to, along with numerous findings in drug stores, the summer bp is quite low, especially after I take the meds. anywhere from 100/60 to 124/75.

Winter a bit higher. I told the doc who thinks I need more meds this and he says, "we'll I guess there is something to this white coat syndrome"

The only thing that gets me is that my pulse is very low, in mid to low 40's upon waking. I do take beta's. So I drink cawfee to feel more alive.

But white coat does indeed exist, best to get other readings at drug stores to average it out. Even the docs bp machine can be out of whack.

Keep in mind that the inner anxieties even in an apparent calm person can shoot hormornes into the system raising pressure. In some people salt does it, in some anxiety does it, we are all different.
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Old 12-15-2008, 11:08 AM   #17
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I too have the syndrome, but I also have hypertension. I also have an Omron monitor which is accurate. The challenge is that you can't come home after a high reading at the quack's office and just take your BP once and say "Oh, now it's ok!" You need to take it about 6-8 times a day, and average the readings. I used to fool myself a bit into thinking I didn't really have a problem. More readings convinced me otherwise, and I now take two meds a day.
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Old 12-15-2008, 06:54 PM   #18
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Originally Posted by freebird5825 View Post
Not a bit. my doc and his staff are really wonderful people. i'm one of those lucky 120/60 something people.......

.....i'll bet my BP goes up at the dentist though.

try this - if my GP doc is running late, i just stretch out on the exam table and take a nap......
Both my Mom and Dad had White Coat Syndrome...always much higher BP at the Doc's office than when they took it at at home. I was fortunate not to experience WCS at the Doc's.....but I known the dentist causes it for me!!! When I've had to go see the oral surgeon, he's taken my BP, and it's always been much higher than at the Doc's. Fortunately, the OS is the one who discovered the 170+/110+ this Spring, and ordered me to see my Doc! Glad he did!!!

I have had high BP....179/114 (give or take a 1 or 2). Taking 1 pill each night before bedtime, it's now a fairly consistent 120/70. Two weeks ago I stopped in my Doc's office to say "Hi" and he checked it....115/70. I went in today for my normal appointment, and it was 130/60......the 130 must've been due to having to drive on the solid sheet of ice on the streets to get there.

My standard appointment time is 9 a.m. (1st appointment of the day...he opens at 9 a.m.), normally on a Monday. I get to his office at 8:30 a.m., visit with his nurse (have known her for years), visit with him when he gets there (he's one of my neighbors), visit with his receptionist.....if she's not late as usual (went to school with her). That way I usually have plenty of time to 'chill' before he checks the BP.....plus find out about new restaurants and new recipes! I'm very relaxed there...they're like family.

Today I left home earlier due to the very icy streets...had sleet & freezing rain last night, and temps down to +5. I got there about 8:25 a.m., the nurse had just arrived and opened the office, and Doc came in about 5 minutes later. I was out of his office at 8:55 a.m., went down the street to the pharmacy to get prescriptions refilled as soon they opened at 9 a.m., and was home at 9:15 a.m.
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