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Old 10-24-2007, 02:41 PM   #1
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Please Help with Question about White Coat Syndrome

My bp at home is in normal range 120/80 sometimes lower , sometimes a little higher. Nearly everytime at doctor's office , my bp is 150/87 or so. This has been over a one year period. I have had to go to the docs alot because of alot of health issues, so this has happened alot. My pcp wasn't /isn't concerned but he did order a tread mill stress test- the cardiologist who conducted the test said I did fantastic and no signs of hypertension. That my heart is very healthy for a person in their mid 50's and the test show more like a heart of a person in their early 30's. Also my lipid profile is great. I get alot of exercise and eat well. This 150/87 at the doctors office repeatedly is getting to me and making me wonder if something else is going on here. I have been listening to South Beach Heart Program audiobook on cd (it is very informative) and the doc says you can do great on the stress treadmill test and still have blocked arteries , and the best way to find out is a heart scan. The last doc I saw a dermatologist said my heart situation should be discussed with my pcp BUT she thought that something could be done with a med on the day I go to the doc. Any ideas about the one day med idea to keep my bp from going high on the day of a doctor office consult? Also any thoughts on if there might be something else here and I should do the heart scan. I read there is alot of radiation with the heart scan and that is a concern.
P.S.- I have tried breathing techniques and meditiation etc. No help with the white coat. Probably helpful otherwise but not with the problem.

 
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Old 10-28-2007, 10:28 AM   #2
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Re: Please Help with Question about White Coat Syndrome

I wanted to give it one more try to see if anyone has a suggestion on how to deal with the white coat problem. I have done some reading and wonder if taking a beta blocker on the appt day would help. I have seen that performance artist who suffer from stage fright use Inderol on day of performance to control bp. Any thoughts on one day use of beta blocker just on doc appt. day?

Last edited by osteoblast; 10-28-2007 at 10:28 AM.

 
Old 10-28-2007, 10:52 AM   #3
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Re: Please Help with Question about White Coat Syndrome

As a long-term veteran of white coat, I can tell you there really is no way to conquer it...you need to find a way to simply live with it, as tough as that sounds. I have tried anxiety-medication, hypnosis, deep-breathing, and absolutely nothing has worked.

What have worked on occasion are being distracted by something during the BP test. What has also worked to some degree is forcing yourself into a mental state where you simply don't care what the reading is.

The brain-body connection is a powerful one, and tough to break. You can be as calm as can be, and if the subconscious is worried about elevated BP numbers, then you are going to get them when the doctor takes the reading.

Keep a long record of home readings as an alternative and take some comfort in the fact that those are good. Doctors take these more seriously now than they used to, and if you have months of good home readings, that will count more than the high doctor's office ones.

tamuprof45

 
Old 10-28-2007, 12:29 PM   #4
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Re: Please Help with Question about White Coat Syndrome

Hi,

congratulations on your fabulous test results!
Do not worry about your heart. You are not showing any symptoms of a cardiovascular disease. Nor do you mention having any cardiovascular disease risks. The stress (and other) tests can sometimes show false positives or negatives. You are correct in saying that it can happen. Given your very healthy lifestyle and the absence of any symptoms of CVD, you most likely have nothing to worry about. A complete cardiological workup is done usually only if there are symptoms of CVD and/or multiple CVD risk factors. According to my cardiologist, one of the best diagnostic tests is the nuclear stress test. It is very accurate.
I have never had any problem with the white coat hypertension, so don't have much in way of an advice. Tamuprof's extensive eperience in dealing with this issue might help you. If, for any reason, your doctors don't believe that your blood pressure readings are fine at home, ask for an ambulatory blood pressure monitor. Good luck with your treatments!

P.S. Sorry your post got missed somehow. Thankfully, tamuprof noticed and posted a reply.


flowergirl

Last edited by flowergirl2day; 10-28-2007 at 12:45 PM. Reason: PS

 
Old 10-28-2007, 02:41 PM   #5
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Re: Please Help with Question about White Coat Syndrome

Hi OZ,

Sorry I went back & couldn't find your post so that is why I haven't responded.

I am the Queen of "cuff anxiety." Most people aren't afraid of DRs so I don't like the term WCH. Tam is probably the KING so you came to the right place!!!

I didn't find Inderal as effective as Labetalol.


I take 200mg of Labetalol before going to the Dr's. You would probably only need 25mg. It works pretty well.

You must be careful taking this drug so that you don 't get withdrawal symptoms.

Your cuff anxiety will only get worse. Good readings will help decrease that reaction. But you will always have this thought in your brain that your b/p will go up at the Dr's.
Medication will help keep that reaction at Bay.

It is very important that you make sure your b/p is not going up at home in stressful situations.

Also, make sure your b/p monitor is within range with the Dr's.

Other tips

Don't drink any caffeine before appointments

Limit your fluid intake to a glass of some kind of fluid but don't drink an hour before the appointment.

Do walking etc when you first get up but not within an hour of the appointment.

Take an ice cream cone to eat while you are having your b/p taken. I actually did that & got a great reading.

Think to yourself it's not your problem. Let the Dr's & Nurses deal with it.

When both numbers go with, it is likely that you have a surge of adrenalin that is going to have to play out. So walk etc after the appointment.

It is normal for b/p to go up about 20-30 points (systolic) at the Dr's office according to Dr. G.

You are not likely to have a stroke or HA with those numbers. My husband's b/p was 230 when he had his Heart attack. His b/p is normal at other times.

Fam

Last edited by famnd; 10-28-2007 at 02:45 PM.

 
Old 10-28-2007, 05:57 PM   #6
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Re: Please Help with Question about White Coat Syndrome

Dear King Tamu and Queen Famnd- thank you for responding to my question. It seems that the royals are not in complete agreement here. The king says not much to be done about this. The queen says perhaps Labetalol. So, I wonder about whether my doc is going to agree to a beta blocker on a sporadic basis when I go to the doc. On another board someone said they took xanax on the doc appt. day tp help them with anxiety and high bp. The thing is I do not feel tense, in fact I would say I am calm but my heart is off to the races- I guess this makes me sound pretty out of touch with my body!! My doc doesn't like writing prescriptions- which may be a good thing. But, if I could get some help on this with a drug that wouldn't hurt me - than why not? Anyway , I see him tomorrow and my guess is that he says he's not worried about the high readings. I am concerned though that I may be hurting my heart etc. I have had alot of doc appts lately so I don't want damage to build up if I have to keep going to the doc on a regular basis. I wish there was a way to deal with this without drugs because in the end I don't think the doc will want me to take anything. I will let you folks know how it turns out. Thank you again for your kind help.

 
Old 10-28-2007, 06:32 PM   #7
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Re: Please Help with Question about White Coat Syndrome

I felt the same way about taking a med to see the Dr. but after 4 yrs, I'm here to tell you that unless you get this anxiety under control it will increase your b/p at the Dr's AND eventually it will go up at home. Then you will be taking b/p meds for a induced Hypertension.

I don't feel particularly anxious when I go to the Dr. either, I just want to get my med Rx and go about my business.

Luckily for me, my Dr. suggested that I take extra pills for this situation, once she was convinced that I was responsible & wouldn't do myself in. Lebetalol is given in the ER for HBP. I take lebetalol & HCTZ (diuretic) on a regular basis too.

I personally wouldn't be taking extra meds if my b/p was in the 150's either.
But if you are going to worry about your b/p at the Dr's, then taking it would help prevent you from setting up a pattern concerning your Dr's visit & having your b/p taken.

Some Dr's would get upset with your b/p because of the new guidelines.
That's where the problem comes in. They scare you to death.

My b/p goes up to 230/ 90 if I go without taking extra meds so I have to take them.

Example: I finally saw a super b/p specialist at a major medical center. My b/p was 178/ 85 at the first visit. By the 3rd visit it was 230/110 or 120. He just went blastlistic with my b/p & went on & on until I was a basket case. I didn't need to have him tell me of all the horrible things that could happen if my b/p didn't come down. I was well read on the subject. He did come up with a partial solution but I had to do the leg work needed to implement his advice ( I was allergic to the dye in HCTZ so it was quite a feat to find a source without the dye ). Then there were insurance problems & on & on.

These meds are life saving but they can be very dangerous. I have permanent damage to my knees, upper arms, hands, from one of them.

Fam

 
Old 10-28-2007, 08:06 PM   #8
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Re: Please Help with Question about White Coat Syndrome

[QUOTE=famnd;3280293]I felt the same way about taking a med to see the Dr. but after 4 yrs, I'm here to tell you that unless you get this anxiety under control it will increase your b/p at the Dr's AND eventually it will go up at home. Then you will be taking b/p meds for a induced Hypertension.

This is my fear: that my anxiety is in fact creating induced hypertension. Mine is actually "cuff anxiety" rather than white coat, because my anxiety does occur at home. Oddly my doctor readings have dropped, while my home readings have risen, so 128-132 systolic is now the norm at home or the doctor's. I suppose I have stressed myself into prehypertension, and now hypertension is next.

Its amazing how this anxiety works. I was getting really good readings under 120, until I came back from Mexico. What has really set me back is a reading of 132/74 during relaxation/desensitization therapy. The therapist thought it was odd since I was relaxed, which has really made my anxiety worse. Now I'm convinced I have something truly wrong, if I could get a reading like that under therapy. Subsequent readings have been pretty much the same.

tamuprof45

 
Old 10-29-2007, 02:37 PM   #9
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Re: Please Help with Question about White Coat Syndrome

Thanks tamu and fan-
I am back from the doc. He wanted me to come in for a ten minute appt. I had another appt. at the clinic , so it was no big deal to add the ten minute appt. Anyway, he greeted me with a very nice smile and seemed extra kind today- I think he wanted to give me the message"do not be afraid of me". Well, it was nice. I like the way he makes an extra effort. Bottom line is he doesn't want me to go to meds for a doc appt. , he said that while beta blockers are used for performing artists to quiet the fight or flight- I do not have to perform at the docs office. Well , he has a point there. His thinking is that the more I make of the white coat , the more exaggerated it could get. He wants me to take my bp , an hour or so after getting up. He says it is higher then- getting up from sleeps strains the system. And, he said there is another high in the afternoon. Anyway, he wants to see the daily high over a month, taken about 3-4 times a week. So, I just need to do this and see what happens. Right now I feel like if it goes up big deal, I will go on a med.But, I don't want a med. So, I am also going to really work on lifestyle aspects which I feel already good about but I am going to be really good about diet and exercise. I don't know if I already put this on this thread but- I just finished listening to South Beach Heart Health Programand it was an eye opener. This guy is great. Somehow it has put me at ease. It just doesn't seem like such a big deal. I think the important thing is do what you can and be sure you are monitored and get the proper tests and nothing should creep up on you then. So maybe with more knowledge I can change things- we'll see. I highly recommend this book/cd if you want to know what you can do with lifestyle changes and how to check up on your doc to be sure you are getting the diagnostic tests you should get.

 
Old 10-29-2007, 03:31 PM   #10
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Re: Please Help with Question about White Coat Syndrome

You are a very lucky woman to have such a Dr. who understands. I totally agree with him. If I had him for a Dr. I probably wouldn't be on so much medication. My primary care Dr. is pretty good but some of the other Dr's get a little hyper. Keep us posted on what you learn from from the CD.

Fam

 
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