White Coat Hypertension or White Coat Effect - What is the Difference?

[Fearless Tower]

Can someone in the medical world explain what the difference is between these two terms?

The definitions I have found online seem to be interchangeable, but I noted there have been studies that indicate people with White Coat Hypertension have higher mortality rates than people with normal BP while they cannot find a similar correlation for those with White Coat Effect?

I asked my own doctor recently and she did not know. I suppose the studies themselves define it, but they require expensive subscriptions.

 

[Rgbeard]

I’m unaware of these as being different things.

 

[Salty]

One sounds generic, where the other is more specific. White coat effect can cause other issues besides higher blood pressure. It seems like white coat hypertension is a subset of the white coat effect.

 

[Let'sgoflying!]

If you are having trouble with WCS (high BP at Dr office but normal at home), my wife discovered she can use a smart BP device that connects to her phone and she can present a chart of home readings over the last month which helps the medical office to realize the readings in the office are WCS. I think its the Livongo I asked about in a previous thread.

 

[AggieMike88]

There was the visit when the super cute nurse held my arm in place between her bicep and chest while placing the cuff on me. My palm was facing inward.

That definitely created a few extra points on the reading.

 

[AggieMike88]

If you are having trouble with WCS (high BP at Dr office but normal at home), my wife discovered she can use a smart BP device that connects to her phone and she can present a chart of home readings over the last month which helps the medical office to realize the readings in the office are WCS. I think its the Livongo I asked about in a previous thread.

I have done this with my doctor. Works out just fine.

I have the Withings BP cuff that connects to their phone app via BT.

 

[chaser]

Can someone in the medical world explain what the difference is between these two terms?

The definitions I have found online seem to be interchangeable, but I noted there have been studies that indicate people with White Coat Hypertension have higher mortality rates than people with normal BP while they cannot find a similar correlation for those with White Coat Effect?

I asked my own doctor recently and she did not know. I suppose the studies themselves define it, but they require expensive subscriptions.

You should assume that you have genuine "high blood pressure" ie.hypertension, and purchase a good digital BP unit(ex.Omron)for home use, record random BPs, and take your unit with you to check it at your doctor's office against a mercury sphygnomameter.Limiting your sodium intake will definitely help control hypertension, along with medication per your doctor.FAA requirements for bp control,etc. are very easily met, in general.
Check the AHA guidelines& hints(heart.org). My experience as board certified cardiologist.

 

[dmspilot]

Can someone in the medical world explain what the difference is between these two terms?

The definitions I have found online seem to be interchangeable, but I noted there have been studies that indicate people with White Coat Hypertension have higher mortality rates than people with normal BP while they cannot find a similar correlation for those with White Coat Effect?

I asked my own doctor recently and she did not know. I suppose the studies themselves define it, but they require expensive subscriptions.

What are the studies?

 

[chaser]

British Medical Journal in 2019 and ncbi here in the US concluded an increase in mortality due to untreated white coat hypertension.Google it for yourself."White Coat" is anxiety-associated,"labile",often isolated "systolic" hypertension,frequently dismissed as an insignificant health risk.
Semantics aside, ignore it at your own peril. American Heart Assoc.has great information on its website.

 

[Let'sgoflying!]

Limiting your sodium intake will definitely help control hypertension, along with medication per your doctor.FAA requirements for bp control,etc. are very easily met, in general.
Check the AHA guidelines& hints(heart.org).

maybe it's in your AHA link but, 'go take a hike'.
When I started walking/hiking on a regular basis, I about don't need BP medications.

 

[dmspilot]

British Medical Journal in 2019 and ncbi here in the US concluded an increase in mortality due to untreated white coat hypertension.Google it for yourself."White Coat" is anxiety-associated,"labile",often isolated "systolic" hypertension,frequently dismissed as an insignificant health risk.
Semantics aside, ignore it at your own peril. American Heart Assoc.has great information on its website.

I was asking for the studies that differentiate between white coat hypertension and white coat effect.

 

[chaser]

I was asking for the studies that differentiate between white coat hypertension and white coat effect.

They are the same vernacular, nonscientific terms.Personal experience or anecdotes should never be a basis for drawing generalizations.

 

[PaulS]

If the concern is whether or not to take the BP meds, my advice is to take them... oh and don't go on the internet looking for problems others have had on the meds. I started about 30 years ago on BP and cholesterol pills, both have been no big deal and do a good job of controlling what they are supposed to control. I have a couple friends who decided to not take the pills. They have had heart attacks. Anecdotal I know, but....

 

[wrbix]

Neither are generally medically recognized terms (per ICD-10 Dx codes) and are interchangeable in general use.

Be aware that almost all studies showing increased mortality/morbidity in patients with hypertension are historically based on BP’S measured in health care settings by health care professionals. I ve always advised that those who think they “only” have white coat hypertension consider further intervention.

 

[-KLB-]

Personally, if your BP is borderline enough that it stresses you out, you probably owe it to yourself to either up your exercise to get it under control, or get on medication. Once you know it isn’t putting your health at risk, you have no reason to get worked up about it when measured in the office.

 

[Zeldman]

Yes I am afraid of white coat folks because....

They're coming to take me away,
Haha, they're coming to take me away,
Ho ho, hee hee, ha ha,
To the funny farm
Where Life is Beautiful all the time
And I'll be happy to see
Those Nice Young Men
In their Clean White Coats
And they're coming to take me AWAY,
HA HAAAAA

 

[Sifossifoco]

Both definitions are mostly used by people in denial, trying to convince themselves that they don't really have high BP. It is understandable, but silly. There is nothing wrong in taking a couple of pills if they make your life longer (as an aside, some BP pills like the angiotensin II receptor blockers have shown some effectiveness in slowing down aging and preventing Alzheimer's. It may be worth taking them even if your BP is not that bad...).

 

[Salty]

Both definitions are mostly used by people in denial, trying to convince themselves that they don't really have high BP. It is understandable, but silly. There is nothing wrong in taking a couple of pills if they make your life longer (as an aside, some BP pills like the angiotensin II receptor blockers have shown some effectiveness in slowing down aging and preventing Alzheimer's. It may be worth taking them even if your BP is not that bad...).

Well, it's not really good to be on too high a dose than is needed either. Low blood pressure is more of an immediate threat, but is something to worry about.

 

[Fearless Tower]

I was asking for the studies that differentiate between white coat hypertension and white coat effect.

It think this is the primary study:
https://www.acc.org/latest-in-cardi...01/cardiovascular-events-and-mortality-in-wch

Reading it again, they seem to be referring to White Coat Hypertension as untreated and White Coat Effect as 'White Coat Hypertension that is being treated'

Just seems odd to use two different terms.

 

[Fearless Tower]

I'm mostly trying to understand if I have a condition and what is it really, because it doesn't quite match the classic definition of White Coat Hypertension - My BP behaves exactly the same in the doctor's office as it does at home.

At the beginning of the Pandemic when I put on a bunch of weight and couldn’t go to the gym, I was experiencing elevated BP and went on meds (fully disclosed on Medical- no big deal).

After a few months, I started to experience adverse side effect from the med and in consult with my doc we stopped the medication and went forward with regular BP monitoring (I was back to regular exercise at that point).

Since then, doing regular monitoring, I noticed that my initial BP reading is always high whether at home in the doc’s office. And it seems to be very much psychological (I feel my heartbeart start to increase as soon as the cuff starts to inflate).

For example, I went in this week and the first reading in the office was 140/85. The nurse took a second reading less than 60 seconds later and it was 120/78. Heart rate back to normal on second reading. My body does the exact same thing at home when I do it myself. I can sit in a chair and do nothing for 5 minutes and the first read will be high and all subsequent readings will be normal. I think it all started with the people at the dentist office freaking out about the initial readings and the flying (and Navy) implication got into my head.

My home BP monitor even has some method of sensing if I’m resting or not and will always show red (not resting) on the first reading then goes green on second or third reading.

At any rate, Doc was willing to go either way, but we decided to try another low dose medication that is FAA approved and see how it goes. I’m heading to Japan for a few weeks, so will be able to adjust to it and have a follow up visit when I get back in plenty of time for my medical renewal.

 

[kell490]

I can't find a home BP monitor that works on me they are all read much higher then what my doctor gets taking it manually. I took the 3 of them into his office he verified I was using them correctly got the same inaccurate numbers. He told me to just go by what he gets at the office which it's normal range 127 over 78.