Why Does My Blood Pressure Spike at the Doctor's Office? Understanding "White Coat" Syndrome

If you’re at risk for high blood pressure due to familial history, conditions like heart disease or diabetes, or any other reason, your doctor may have advised you to take your blood pressure at home using an approved device. You may find your concerns are much relieved because your BP readings seem to be within the normal range.

However, when you visit your doctor, your readings are invariably higher. Why and how does this phenomenon happen, and how can you reconcile your normal readings at home with the high readings at the doctor's office?

At West Houston Heart Center in Houston, Texas, Dr. Humayun Naqvi and his team provide preventative cardiology, which means that we perform routine checks of your blood pressure at our office every time you visit. If your blood pressure is fine at home but high when you visit us for a check-up, we can explain why.

Understanding blood pressure readings

Blood pressure readings include both your systolic reading and diastolic reading. The systolic reading is the pressure generated by the heart when it pumps blood out into your body. The diastolic reading is the pressure in your blood vessels between heartbeats. These numbers are typically reported as “(systolic ) over (diastolic),” as in “110 over 70.”

If you have normal blood pressure, your systolic reading will be below 120 and your diastolic reading will be below 80. If either number is higher than this baseline, then you’re experiencing high blood pressure. If the systolic reading is below 90 or the diastolic reading is below 60, you have low blood pressure.

White coat syndrome

If your blood pressure consistently seems fine at home, but elevates at the doctor's office, you might be experiencing what is colloquially called “white coat syndrome.” This typically means you get nervous or worried about having your blood pressure taken, since if it’s a high reading, it could mean you have hypertension and associated health issues.

This can end up being no more than a self-fulfilling prophecy. You’re so worried about having a high blood pressure reading that you get anxious, and the anxiety itself causes a high blood pressure reading. If you consistently have good BP readings at home and only show a slightly elevated reading in our office, that’s likely the reason.

When white coat syndrome points to a bigger problem

There are two ways that white coat syndrome can be more serious than assumed. If you aren’t monitoring your blood pressure at home, then you could be misdiagnosed with high blood pressure even if you don’t have it. Medications for high blood pressure can prove dangerous if administered to someone with normal blood pressure.

Alternatively, if you have low blood pressure issues, but every time you go to the doctor you have a normal reading, your problem could go undiagnosed. Your white coat syndrome artificially raises your blood pressure into the normal range, but your BP drops outside the office, and you run the risk of dizziness, fainting, and other symptoms of low BP.

The best way to avoid complications from white coat syndrome is to buy an approved blood pressure monitor for use at home and have your doctor show you how to use it correctly. This can help you establish what your normal baseline is, and you can properly discount any readings caused by white coat syndrome. 

Interested in learning more about your blood pressure and what can cause you to have high or low readings? Call us at 832-400-3957, or book your appointment online today.