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Old 09-29-2006, 07:51 AM   #1
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alleycat2 HB User
white coat syndrome need advice

I had high bp due to stress before I got pregnant, at least that's what the Doctor thought and I was put on meds that helped control it on a as needed basis. Now that I am pregnant the Doctor is freaking out about my bp even though he should know by now it's not caused by the pregnancy. He is worried it is harming the baby and has done tests and is still doing tests but the baby doesn't seem to be affected at all. No preeclampsia or anything like that, infact the baby was bigger than the Doc figured and then he started freaking out about possible diabetes, which isn't true ethier. Anyway he has me getting my bp checked every week by his nurse, who I feel confortable with, and whenever she does it it is great. My bottom numbers are anywhere from 72 to about 80. When she checks my bp she takes it in her office not in the exam room. However the minute I walk into the exam room to see the Doc. for my next official appointment my bp will be up with the bottom number measuring about 85 to 96 and once it hit 100. He looked back in my chart since before I was pregnant and said maybe I have what he calls white coat syndrome. He never said anything to me but he noted in my chart that he considered possibly taking me off work early if it was too stressfull and kept making my bp go up before the baby is born. I don't want to do this because I want to get in as much time with my baby after he is born before having to return to work. Anyway my question is this... has anyone found a way to overcome this so my bp will come down and I can stay at work until I actually have baby?

 
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Old 09-29-2006, 01:49 PM   #2
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Re: white coat syndrome need advice

Hi there

I am not pregnant yet but I can relate to your story. I would like to TTC but I have hypertension (it is always much higher at the doctor's office than at home and every doctor I have seen is fixated on the numbers they see in the office. I aways monitor my blood pressure at home and my readings are always completely normal) I was placed on an ACE inhibitor for my blood pressure a couple of years ago and recently because I want to try to get pregnant I was switched onto Methyldopa because it is safe to take while pregnant, unlike the ACE inhibitor. Anyway being on Methyldopa has dramatically lowered my blood pressure at home but at the doctor's office it is still around 146/96 (at home my numbers are 110's-120's/60's-80's) She keeps freaking out about the numbers she sees in the office and claims that if I were pregnant, me or my baby would die and I would have preeclampsia and possibly start to have seizures. I realize that this is the worst case senario but it is still scary none the less. Anyway to make a long story short, she is sending me to a specialist who deals with high blood pressure in pregnancy which I am quite happy about, I hope she can provide me with some better information.

Are you currently taking any medication for your bp? Are you monitoring your bp at home? If so, are your numbers okay? Bringing this information with you might help your docotr realize that your bp is normal most of the time. It sounds like you are getting good care, but I know how it feels to not have people understand that your bp is otherwise under good control.

Good luck and keep me posted with your pregnancy goes because I know I will be dealing with this same issue when my time comes.

 
Old 09-30-2006, 05:18 AM   #3
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Lenin HB UserLenin HB UserLenin HB UserLenin HB UserLenin HB UserLenin HB User
Re: white coat syndrome need advice

alleycat,

Buy a blood pressure tester, digial and self-inflating are most convenient.
Test regularly when resting at home in a comfortable chair (I take 3 readings each time and toss the 2 high and 2 low numbers...record the middle values.)
Keep a thorough log of your readings.

Average the systolics and average the diastolics on a monthly basis: THIS IS YOUR TRUE BP.

Show the log to your doctor WITH THE AVERAGES (or else they point to ONE high number and give you an Rx.)
If indeed, the average diastolic is over 90 then you need a medication but make sure it is one that can be safely taken during pregnancy...there aren't many! But if your average is below 90, the best medicine for you and your baby is NO medicine.

Last edited by Lenin; 09-30-2006 at 05:19 AM.

 
Old 10-02-2006, 08:24 AM   #4
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Unhappy Re: white coat syndrome need advice

I am not on meds and the Doctor has said it isn't causing any problems with the baby but he still is fixated on this. My readings with this nurse, whom I feel confortable with are great outside of the exm room but once I step in the exam room they go up again. She isn't worried and the Doctor didn't push or even mention what he had noted to me in his chart and she is sure things are fine. She claims the readings aren't that high for my stage of pregnancy which is currenlty 36 weeks and 2 days today. I read in my book that duirng then end of the pregnancy your bp gets higher. Her idea of high bp and the Doctor's idea are different however. Now that she has changed from being a nuring assitant to practically a doctor she sees me like I was a normal patient in an exam room and now has a nurse to check my bp instead of her doing it and once I step in the exam room it goes up again. I am figuring now that the Doctor will see my bp has high every week now and freak out more. Where as before when she took it in her office every other week it was great and he knew it had to be because of the white coat syndrome! What will he want to do now? That is why I need advice on how to keep it low and get over this if possible.

 
Old 10-02-2006, 08:37 AM   #5
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Uff-Da! HB UserUff-Da! HB User
Re: white coat syndrome need advice

Follow Lenin's advice. Buy a BP monitor and keep a record of your home readings. Take your record with you to the doctor. People with serious "white coat" symptoms may never get over it, so you can only work to get around it. The other possibility is to ask for an ambularory BP test, where you get a monitor that takes your pressure every half hour or so for 24 hours and creates a log of the readings for the doctor. That would show "officially" that your readings are normally fine.

Last edited by Uff-Da!; 10-02-2006 at 08:37 AM.

 
Old 10-02-2006, 09:26 AM   #6
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Sara1978 HB User
Re: white coat syndrome need advice

Unfortunately, Uff-Da is right. There is not much you can do to "fix" white coat hypertension. All you can do is prove to your doctor that your readings are normal except for when your are in his office. The stress surrounding this issue I am sure is not helping the situation at all (which I know all too well). Ask lots of questions. Like, what is his defantion of white coat hypertension, which readings do they take into account just the one in the office or, the 20+ that you provided from your home monitor which are normal. The last time I went to my physician and she started freaking out about the 146/96 I asked why she is only basing my blood pressure on the reading she gets in the office and not by the 40+ (I take my blood pressure VERY frequently at home) I take with my home monitor. That is when she suggested sending me to a specialist to see if she was okay with this reading. I have also told her I have done tons of research (not just internet searches but acutal published scientific studies regarding the issue) Pub Med #10455476, an abstract which showed white coat pregnancy outcomes were better than true chronic hypertension in pregnancy. There are also many other studies done regarding this issue, but most on hypertension and preeclampsia.

Unfortunately, sometimes you just cannot win this argument and especially in pregnancy when there are 2 lives at stake, doctors seem to take the slightest raise in blood pressue very seriously, which they should. As I am sure you know, it can cause very serious problems. It sounds like you and your baby are doing fine, especially if there are no signs of preeclampsia. All you can do is take your blood pressure at home and hope that your doctor finally understands!

PS - A 24-hour ambulatory blood pressure monitor is another good idea, as Uff-Da suggested. Depending on your location these may be hard to come by. I live in Canada and have not had any luck in getting one done.

Last edited by Sara1978; 10-02-2006 at 09:32 AM.

 
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