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georgef 11-01-2001 11:22 AM

White Coat readings even at home?

I'm 35 and have been getting high readings at the
doctor's office, as high as 150/95. I lost 30 lbs
to get down to my optimal weight, have been running
4 miles/day for about 9 months, and have reduced

I use one of those Walmart ReliOn monitors with the
hand pump. I try to measure my blood pressure every
couple of weeks, but I always feel nervousness before
I do it (performance anxiety: I want that sucker to
be low!! <IMG SRC="">). Thus I'll get a reading of 140/85 or
144/82 or something like that. If I take the cuff
off and wait 4 minutes, the reading is always lower,
usually something like 130/83, or sometimes even
in the low 120's for the top number.

Am I doing this right? Is it "fair" to wait 4 minutes
and then retest? For one thing I AM calmer for the
second reading, and my pulse usually is lower
(sometimes 85 on first reading, 65 on second).
I've read the manual of course but am skeptical that
the second reading is always better.

One other q. On a similar note, is it "fair play"
to rest for 10 minutes and be rather calm when
taking this reading? If I sit down, place the cuff
on and fire it is always higher than when I have
rested for a few minutes first.

Thanks for any thoughts you guys might have. I'm
convinced the readings at the doctor's office are
too high, but am unsure whether I'm getting
the real scoop on these measurements at home as well.


Dan K 11-01-2001 01:58 PM

Re: White Coat readings even at home?
I am 35 as well. When I go to the doctors office, my readings are generally 150/95 or even a little higher! Of course, at home, my readings are closer to 130/85 or lower. Do I have high BP? The doctor says YES. No one has given me a straight answer. Apparently, if it is high at the doctors, then it is HIGH. I disagree, but am currently still working with my doctor to determine this. The best way to find out is to purchase an OMRON self inflatable monitor, test yourself at home twice or more a day (same time everyday). When you test yourself, sit in a chair (with a backrest) for 5 minutes, then take it. Record your readings like this for a couple months. Average your readings and this will give some idea, plus it allows you to see trends. Good luck!

JJ 11-01-2001 02:56 PM

Re: White Coat readings even at home?
Dan is 100% right. I bought the Omron self inflateable and had it checked by 2 different drs., pretty much on target. I was told to take it exactly as he described, and my readings were naturally lower at home than the dr., but when I took it in, I got almost the same reading on mine as she got. If it is consistently high even at home then U may need some meds. to bring those numbers down,I did. Good luck, and stay healthy!! JJ

JaniceS 11-07-2001 09:26 AM

Re: White Coat readings even at home?
I have the same problem. What has helped me is to take it more frequently than once every few weeks. I measure mine every few days. I think it's a psychological thing, but by measuring it frequently, (in my mind) any one measurement has less relevance, thereby making me calmer whenever I do measure it. If I get a higher reading one day, but back down to normal 2 days later, I don't stress about it.

Zack 11-15-2001 03:50 AM

Re: White Coat readings even at home?
I think if you suspect white coat syndrome you have two choices -- just forget about it or try medication (e.g. a small dose of a beta blocker) and see what happens. I always get high readings at the doctors but i'm pretty much normal at home. Most docs ignore this information. Infact even without any meds i was running 100/60 last night! (normally i'm about 120/70 at home) yet when i visited my doc today i was 160/100 and she insisted i should be on 50mg of atenolol .. what am i to do?? obviously if she tested my pressure as 100/60 there is no way she would pump 50mg of atenolol into me. i think it's quite a dilema how to treat labile hypertension like this ... no doubt 'hot responders' like us ......... i get light headed on beta blockers but even on meds my pressure leaps up in the doctors office! using an ambulatory monitor my pressure was up and down all day. hard to know how to treat this.

Ultimately the choice is yours -- your doc my press you to take meds as otherwise he might be accused of 'neglecting' your health and he doesn't have many other options. You can choose not to follow his advice and seek other solutions. In the end don't get mad with your doctor he is just following protocol. If you disagree with him get a second opinion and if you still disagree with that treat yourself. Your health is your own business.

Dan K 11-15-2001 09:25 AM

Re: White Coat readings even at home?
This is indeed an interesting dilemma. Hard to say if white coat hypertension is truly HBP. Anyhow, I read some studies that people who are susceptible to WC Hypertension are more likely to indeed have HBP. I guess I look at it like people with HBP have HBP almost all the time - perhaps even when they are sleeping. I do not have elevated BP all the time - only some of the time - particularly when I go to the doctors office (155/100). Yesterday at home it was 122/83. Hmmmmmmm. My doctor has prescribed a low dose of Coreg to deal with this. I do my part by trying to watch my diet and by exercising extensively. DK

Zack 11-15-2001 07:59 PM

Re: White Coat readings even at home?
The unfortunate truth is that those with whitecoat response (probably an exaggerated stress response in other situations too) may well have a stronger pre-disposition to developing full on HBP if other factors like bad diet, lack of exercise etc. come into play. Others can abuse their bodies and never get HBP, high cholesterol etc. Some of us (for whatever reason) are not so lucky. The key is to live a very, very healthy lifestyle and try not to let the blood pressure to get out of control.

The question of whether to medicate or not is one the medical community has no fixed concensus on. One problem is balancing the side effects of medication with the risks of up-and-down blood pressure.

However one thing i know is I often try to kid myself my BP is better than it is .... sit down to take a reading 144/85 .. ok ok try again .... relax ... 130/79 .. better ... breath .... 125/75 .. good now we're talking .. and so on until i convince myself it's not a bad pressure ...... thing is if i say ask my friend (who's normotensive) to take a sudden spot check on BP she is always well within range on the first reading ...... this suggests my BP fluctuates alot and responds to the slightest stimulus where others are much better and consistently regulated. A possible mechanism of hypertension is that in the end these swings will become a permanent high reading as the blood vessels change and 'damage' from the constant changes. It still doesn't help us with whether we should let our doctors medicate us for life if we suffer fluctuating BP!

Just some thoughts.

Zack 11-20-2001 07:42 PM

Re: White Coat readings even at home?
To continue the talk about whitecoat hypertension this is my story from yesterday ...... i went to see my nephrologist .. the appointment at 3pm. Well my morning pressure was pretty good .... 15 minutes before the appointment i popped into the restroom and took my pressure again ... i felt slightly nervous and had been rushing ... first time reading was 130/80 ... quite okay given i was not that relaxed ......... so the appointment came and bang it's 150/90 and the doc says my meds are not working ( ic ould feel my heart pound as he went to take my pressure -- like a reflex reaction) ... now he wants me on 50mg of atenolol and 10mg norvasc ..... i told him about my home readings and he didn't seem that impressed. Now u know the funny thing .. a while back i stopped all meds for quite some time (without telling my doc -- naughty i know) and my doctor was still recording my pressure at 150/90 .... the stupid thing is that with or without meds it's always 150/90 when recorded by the doc!!

georgef 11-20-2001 09:36 PM

Re: White Coat readings even at home?
Thanks for all of the great replies to my
original message.

I went to see my doc last week and had the usual high
reading in the office (156/90). I have a really
great doctor who is willing to work with me as
a potential "white coat" case. He told me to
take my blood pressure 3 times at home when I'm
relaxed, 10 minutes or so apart and record the
THIRD reading. He said each time I will be more
relaxed and we can probably trust the last reading.
Even my first readings at home are "white coat".
I've been getting a first home reading of 145/85
ish, but the third reading is always below

The only thing I wonder about is whether there
is any physiological reason that the blood pressure
monitor will measure a lower subsequent reading
because of earlier testing: for example because of
some change in your veins or something because of
the squeezing of the cuff? My doctor thought that this
would not be the case. My machine's instructions say
to wait 5 to 10 minutes before taking another reading,
so I wait at least 10. Its always lower the second
and third times.

Therefore I guess no meds for me for the time being
at least....

Does anyone else use the OMRON model HEM-412CREL?

Anyways, thanks again and keep that blood pumping,
just not too hard <IMG SRC="">

Arch 12-17-2001 07:31 PM

Re: White Coat readings even at home?
If you suspect "white coat syndrome" the best bet is to request a 24 hour BP monitor. Essentially it hooks on your belt and takes your pressure every hour during the day then every 2 hours at night.

I'm on meds myself and notice that diet + excercise on a daily basis actually do wonders to lower my readings.

KathleenLamo 12-20-2001 09:23 AM

Re: White Coat readings even at home?
Hi everyone...

Yes! That White Coat Syndrome. So very frustrating. It is best to have a doctor who takes this into consideration. I had a doctor that kept raising my milligrams, then added a second drug, then a third. At the third drug, I put my foot down and refused. I had plans to terminate this doctor, but she got to me first with a registered letter!
I now have a doctor who is more considerate with this, and I am on a lower dose and not on three meds. I think sometimes doctor's can make you feel more stressed out by thinking your a lot worse than you really are. I am comfortable with my new doctor.
But I do agree, any kind of nervousness elevates the blood pressure, especially that top number. It's only a natural thing. But like someone else mentioned on this board, some people are more prone to high blood pressure under the littlest things. Some abuse their bodies over and over, and their blood pressure isn't affected. So a low-dose med. could be in order for those "active" people. <IMG SRC="">


<p>[This message has been edited by moderator3 (edited 03-19-2002).]

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