My blood pressure is always higher in a medical setting than it is at home. Why is this?
Answer From Francisco Lopez-Jimenez, M.D.
You could have white coat hypertension. This condition occurs when blood pressure readings at a health care provider's office are higher than they are in other settings, such as at home. It's called white coat hypertension because people who measure blood pressure sometimes wear white coats.
It was once thought that white coat hypertension was caused by the stress that appointments with a health care provider can create. If blood pressure returned to optimal after the appointment, the temporarily raised blood pressure wasn't considered a problem.
However, some care providers think that white coat hypertension can be a problem. It might mean a risk of developing high blood pressure as a long-term condition. People with white coat hypertension might also have a higher risk of developing certain cardiovascular problems and damage to some organs, compared with people who have steady, optimal blood pressure.
The same might be true for people who have masked hypertension. That means their blood pressure is OK at the care provider's office, but it can spike when measured in other settings. It's thought that even these temporary increases in blood pressure could develop into a long-term problem.
If you have white coat hypertension, talk to your health care provider about monitoring your condition at home. Your provider might ask you to wear a device (ambulatory blood pressure monitor) to track your blood pressure for up to 24 hours. This measures blood pressure during activity and at rest. It can help determine if your high blood pressure needs treatment.
Francisco Lopez-Jimenez, M.D.
June 25, 2022
- Cohen J, et al. White coat and masked hypertension. https://www.uptodate.com/contents/search. Accessed April 7, 2022.
- Faria J, et al. Long-term risk of progression to sustained hypertension in white-coat hypertension with normal night-time blood pressure values. International Journal of Hypertension. 2020; doi:10.1155/2020/8817544.
- Unger T, et al. 2020 International Society of Hypertension global hypertension practice guidelines. Journal of Hypertension. 2020; doi:10.1097/HJH.0000000000002453.
- Nurendini G, et al. Current status of white coat hypertension: Where are we? Therapeutic Advances in Cardiovascular Disease. 2020; doi:10.1177/1753944720931637.
- Mancia G, et al. White-coat hypertension: Pathophysiological and clinical aspects: Excellence Award for Hypertension Research 2020. Hypertension. 2021; doi:10.1161/HYPERTENSIONAHA.121.16489.