White Coat Syndrome

What is White Coat Syndrome?

The term ‘white coat ‘ denotes medical professionals, mainly clinicians. White Coat Syndrome indicates the blood pressure alteration in the medical settings. This variable blood pressure measure is intrinsic. Approximately 20% hypertensive case in comparing with overall hypertension is related to the white coat syndrome.

The systolic and diastolic pressure difference between home and clinic varies about 10mmHg and 5 mm Hg respectively. This estimation is not fixed for every vulnerable individuals, it may more in some individuals. The maximum elevation of blood pressure for white coat syndrome is 30 mmHg. ^(1,2)

Causes

Blood pressure is changeable throughout the day. The blood pressure is quite dependable on surroundings and it rise or fall depending upon the situations happen.

Human tendency has scare feeling in medical settings and becomes anxious during blood pressure checked by the doctor or nurse. This feeling most of us ignoring, but prominent in some individuals. The prominent anxious feeling causes stimulation of sympathetic nervous system. This effect has a direct effect on blood pressure and significant elevation of blood pressure is noticeable. The intervening clinical condition hinders the accurate blood pressure measurement.

The variable identified causes of anxieties in medical settings are as follows:

• Fear of a painful procedure
• Feeling embarrassed about being unclothed or being touched
• Serious condition of other surrounded patients can make somebody tense. ^{(1, 3)}

Detection of white coat syndrome

White coat syndrome interferes the detection of hypertension and cardiac health status. The identification of white coat syndrome is possible by comparing results taken in the medical set up with results, which are taken at home. This can be possible by following ways:

Regular Measuring of B.P.

Self monitoring, digital blood pressure measurement machine has been already available in the pharmacy stores. The suspected individual has to buy this BP measuring machine. Then he/she can measure BP in regular basis and also maintain a blood pressure measurement diary. This record assists to clinician for estimating the blood pressure trend of the particular individual.

24-hour monitoring of B.P.

24 hour monitoring of blood pressure is possible by a medical device known as Holter. The suspected individual has to wear this digital machine for recording the blood pressure throughout the 24 hours. This helps to detect in which time the blood pressure fluctuation is maximized and also measure the circumstances which affect the blood pressure of the individual.

Treatment

• If possible self controlling of anxiety in medical settings.
• Taking a rest for short term before checking blood pressure .
• Effective communication between patient and healthcare staff assists to build a relationship by communicating, so that the patient does not feel any fear in hospital settings. ^(1,2.4)

Is there any chance to detect high blood pressure arises due to white coat syndrome?

• Healthcare staff should consider the probability of white coat syndrome in case of findings of elevated blood pressure before concluding patient is having hypertension.
• If any patient has the white coat syndrome regular monitoring of blood pressure is essential and also averting of medical checking of blood pressure. This also allows patients to take suitable measures for controlling blood pressure.
• Periodic medical suggestions require to clarify doubts or concerns about the white coat syndrome.⁽¹⁾

References

1. White coat hypertension (and white coat effect); Retrieve from: http://www.bloodpressureuk.org/BloodPressureandyou/Medicaltests/Whitecoateffect
2. Thomas G. Pickering (1998) ; White Coat Hypertension: Time for Action; http://dx.doi.org/10.1161/01.CIR.98.18.1834; Retrieve from: http://circ.ahajournals.org/content/98/18/1834
3. Fear of a White Coat; Retrieve from: http://www.webmd.com/anxiety-panic/features/beyond-white-coat-syndrome?page=2
4. Rekha Mankad, High blood pressure (hypertension); Retrieve from: http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/white-coat-hypertension/faq-20057792