What is White Coat Syndrome?

White coat syndrome (WCS) is a temporary elevation of blood pressure caused by excitement or anxiety that does not necessarily constitute hypertensive disease, but may indicate an inclination towards its development.

White coat syndrome occurs in a patient whose blood pressure is consistently higher at a physician’s office than when measured at home. Patients may or may not have an existing diagnosis of hypertension.

Patients with white coat syndrome have an increased risk of cardiovascular disease, although the risk is greater in a true hypertensive patient.

Ambulatory 24-hour blood pressure monitoring is useful in the evaluation of these patients.

What are the causes?

The causes of white coat syndrome are usually always caused by:

    • Fear
    • Dread
    • Worry
    • Excitement
    • Anxiety

These emotions stimulate the fright or flight response.

This stimulates hormones (i.e. adrenaline) and the nervous system to constrict the blood vessels causing a temporary increase in blood pressure.

What are the symptoms?

There are no symptoms of white coat syndrome.

Patients are generally asymptomatic.

How is it diagnosed?

The goal in diagnosis is to avoid unnecessary drug therapy, provide a better diagnostic and prognostic assessment, and reduce costs.

A good way to overcome white coat syndrome is by multiple office blood pressure readings done in a routine fashion, to minimize anxiety.

Blood pressure may also be recorded outside the physician’s office at home or at a local grocery store. This is referred to as blood pressure self-monitoring.

The best way to diagnose white coat syndrome is with a 24 hour ambulatory blood pressure monitor, which is provided here at CVI. This is a small portable monitor that takes regular readings of your blood pressure over the day and night. A 24 hour ambulatory blood pressure monitor allows the physician to assess blood pressure under the conditions of a typical day. Blood pressure will also be monitored during sleep. Obtaining recordings during sleep is beneficial as normal blood pressure decreases or “dips” during sleep. With the lack of this “dip” during sleep, the diagnosis of true hypertension can be clarified.

If you have been diagnosed with white coat syndrome, the risk of developing heart disease is greater and many patients go on to develop hypertension (high blood pressure) in the future.

It is essential to have your blood pressure recorded on a regular basis to ensure that if blood pressure escalates, action can be taken promptly to bring blood pressure down and minimize the risk of heart disease.

Lifestyle modifications are reinforced in patients with white coat syndrome.

How is it prevented?

Lifestyle modifications are highly recommended in patients with white coat syndrome.

This includes:

    • Quit smoking
    • Limiting alcohol
    • Controlling cholesterol and diabetes
    • Eating a healthy diet
    • Reducing your salt intake
    • Keep physically active with the right kind of exercise
    • Maintain a healthy weight with a BMI <25
    • Manage stress: stay positive, optimistic, and most of all calm