The ‘white coat effect’

DID you know that some individuals who are otherwise okay can have elevated blood pressure when they visit a doctor?

A phenomenon known as the “white coat effect”, consultant cardiologist Dr Andrene Chung, in an interview with the Jamaica Observer, explained to Your Health Your Wealth that it is quite common.

“The white coat effect is, you are not hypertensive, you run normal blood pressure readings outside, but when you get to a medical facility or you go to the doctor your blood pressure is measured and it’s high,” she said.

“Or, if you are hypertensive, [your] blood pressure is well-controlled outside and when you go to the doctor it is high,” Dr Chung added.

The cardiologist, who is the medical director of Partners Interventional Centre of Jamaica, explained that the white coat effect is, to some extent, a stress-related reaction. However, she said “it is not something that’s innocuous because we do find that if you follow people with the white coat effect, over time, they do show higher risk for vascular disease”.

Though Dr Chung was unable to provide statistics, she said it is something she sees in her practice.

“It’s quite common actually, we see it quite regularly and a lot of people will come to you and say, ‘Every time I go to the doctor my blood pressure is high,’ so it’s fairly common,” she told Your Health Your Wealth.

However, Dr Chung explained that there are instances that high blood pressure readings might not be due to the white coat effect.

“Sometimes its not true white coat effect, you have to make sure you’re measuring the blood pressure under correct setting…the patient is not talking, you have to be sitting for awhile before you take it. It needs to be measured in the correct way, so that’s the first thing, to make sure it’s being measured properly; but if it is, and you do have the white coat effect, it is quite common,” she explained.

Hypertension, or high blood pressure, occurs when the force of the blood exerted against arterial walls is abnormally high. The condition may eventually cause health problems, including heart disease.

Monitoring of some sort, is one of the tools doctors would use to determine whether a patient is being impacted by the white coat effect or if the patient has hypertension, Dr Chung explained.

“We could ask the patient to monitor at home if they have a monitor, and we have them monitor over a period of time, under controlled situations. We advise them how to do it and they can bring back their readings to us so we can look at it,” the cardiologist explained. “Or we can do what they call a 24-hour ambulatory monitor, which is when we fix a cuff on the patient’s arm and it’s attached to a little recorder, and they go off and do whatever they normally do for 24 hours and, at certain pre-determined intervals, it takes your pressure. So we end up with a whole slew of readings in the course of the patient’s normal day that we can then look at and see really if they are showing elevated readings or if they are really normal.”

— Anika Richards

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