High Blood Pressure Or Reaction To Doctor’s White Coat?

FARMINGTON — For some patients, the alarmingly high blood pressure at their doctor’s office is not true high blood pressure at all. It may be a result of stress brought on by the visit to a doctor or other health professional.

“It’s important to know the difference, so people with normal blood pressure don’t wind up on unnecessary medication,” said William B. White, MD, professor and head of the division of hypertension and clinical pharmacology at UConn Health Center, and the founder and editor of the medical journal Blood Pressure Monitoring. Due in part to Dr White’s research and advocacy, Medicare will soon implement a national coverage policy for the screening that can help tell the difference.

Thought to be a stress response in a medical setting associated with the presence of a physician or other health professional, white-coat hypertension is the occurrence of high blood pressure only when measured in a physician’s office, or other clinical setting, in an otherwise healthy patient. Dr White and his colleagues has been longtime proponents of ambulatory blood pressure monitoring for the diagnosis of suspected white-coat hypertension, and thanks in large part to his research and advocacy, the test will soon be covered by Medicare.

One of the potential benefits for patients is that they may be able to avoid medication. “When patients’ blood pressure readings are high in my office, but they tell me that it’s normal when they take it a home or work, a red flag goes up,” said Dr White. “Often patients with white-coat hypertension are diagnosed with high blood pressure and given medication to control it. In reality, their blood pressure is only elevated in the medical environment, and studies have shown that taking medication may not provide any health benefit to patients with white-coat hypertension,” he said.

Dr White and a handful of his patients traveled to Washington, D.C., to present medical information and clinical histories at the Center for Medicare and Medicaid Services hearings in support of ambulatory blood pressure monitoring for the diagnosis of white-coat hypertension.

With the use of an ambulatory blood pressure monitor for a 24-hour period, blood pressure is monitored during both daytime activity and sleep. The monitor cuff is worn on the upper arm and uses a small microchip that records blood pressure readings throughout the day. The frequent measurements result in more reliable readings and ultimately more precise diagnoses.

“Twenty-four hour blood pressure monitoring provides valuable information to help determine whether a patient is truly hypertensive or exhibiting white-coat hypertension. With that information, physicians can treat patients with more precision, resulting in much better outcomes,” said Dr White. “I’ve been involved with research in this area for more than 20 years. I’m very pleased that the value of this monitoring test has been recognized and will be covered by Medicare.”

As of April 1, 2002, Medicare is covering ambulatory blood pressure monitoring tests for patients suspected of having white-coat hypertension. “We hope private insurance companies will soon follow the government’s lead,” said Dr White.