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Discussion Starter · #1 ·
So I have white coat syndrome. At the doctor's office my BP is 140/90 but at home it is always 120/80 - 110/60 depending on stress and time of day.

My doctor thinks that I must take BP medication because of the increased risk of stroke and heart attack for diabetics. I am taking a clonidine patch but I really don't want to be taking medicine. I infrequently experience dizziness/feintness when going from standing to sitting which indicates that my BP is low and it is quite unpleasant. I didn't run into this before taking the medicine.

When I looked up online how to deal with hypertension every talks about how to fix chronically high BP, not stress related highs. Since it is only high when I am upset, I am not sure if diet changes would be effective?

Mostly I'm wondering if anyone else has dealt with white coat and had any advice for 1) not freaking out every time BP is mentioned and 2) how to get my doctor to titrate me off of this medicine?
 

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Any reason not to switch to a different BP Med?

I am on ramipril, which has been proven to preserve renal function in diabetics. A minimal dose, no side effects. ACE inhibitors seem to be the popular ones now.
 

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Discussion Starter · #3 ·
Any reason not to switch to a different BP Med?

I am on ramipril, which has been proven to preserve renal function in diabetics. A minimal dose, no side effects. ACE inhibitors seem to be the popular ones now.
I'm not sure how one chooses which type of BP meds to use? I looked up how clonidine works and it is supposed to "open up" or relax the blood vessels. So it's not a diuretic which I think is another kind. I don't really understand what an ACE inhibitor is though I hear about it all the time on those pharmaceutical commercials "tell your doctor if you are taking an ACE inhibitor". :D I do know that she has to be creative with which meds I take because of my liver damage (which is why I use all patches instead of oral meds).

The doctor told me today to go to a lower dose and call back next week. I will make sure to ask about a different type of med if I am still feeling bad. Or I may ask just to know! :)
 

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Mine is the same way. I even sit in the car for about 10 minutes before I go in and do deep nasal yoga breathing. But when the nurse takes it is always quite high. My doctor told me to buy a machine and test it at home. At home it is usually 105/75 but in the office it can be 136/85.
 

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Have you ever had them retake your BP at the end of your appt? Sometimes that helps get a more normal reading.
 
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Discussion Starter · #6 ·
I am learning how to do "diaphragmatic" breathing at physical therapy, I'm not sure if it will work but I can try doing that 5 minutes before and while they take my BP next time.

I have told the nurses every time I see them that I have white coat and that I don't calm down until AFTER I have talked with the doctor. They always insist on taking my BP 5 minutes after I walk in the door anyways. I think it's time to tell them that it's MY health and they can darn well take it after I see the doc. I am fed up with being bullied by nurses and doctors!
 

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My doctor wanted to up my dose of Ramipril from 5mg to 10 mg. She asked what it is at home or bp machine at the stores and told her. She said she is not to worry about it since a avg 115-120 / 75-85. The dr checked it at the end of the exam it came down. Maybe ask the dr to check it and not the nurse.
 

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Discussion Starter · #8 ·
Yeah I am much less apprehensive with my doctor than those nurses. She's much nicer. :p If she took it after talking to me it would probably be much closer to my home #'s.
 

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As we proved yet again this week when my everlovin' had his dr. appt., even docs themselves have white coat hypertension. His b/p readings at home are nice & low - well inside the danger zone. Not so when he's in the exam room! :p
 

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Discussion Starter · #10 ·
As we proved yet again this week when my everlovin' had his dr. appt., even docs themselves have white coat hypertension. His b/p readings at home are nice & low - well inside the danger zone. Not so when he's in the exam room! :p
If you don't mind my asking, is your husband taking blood pressure medication? I guess I'm wondering if a doctor would take BP meds if he knew that it was only high in the exam room. I can see that my doctor doesn't trust me and figures I must have elevated BP all the time. But if you are a doctor, maybe you would trust the home #'s more and not take the meds?
 

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He's been on a low dose of Maxcide (triamterene and hydrochlorothiazide) for the last coupla years, because even his home tests were creeping up around borderline. Plus he's 77 years old now, which may account for some of that. But now that he's on meds, it's only the exam room readings that are borderline.
 

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I'm a little late to the party here, but I have the worst white coat syndrome ever. My blood pressure skyrockets, I get heart palpitations, and I have trouble breathing. What's worse is that I now have anxiety about my anxiety, so I have several emotional breakdowns before every doctor's appointment. Knowing I have an appointment ruins my entire week. I have trouble sleeping, eating, and working.

Before my appointment, I sit in the waiting room with my head in my hands trying to slowly breathe myself into calm, but that never works.

I have talked to several doctors about this and only my last doctor seemed to care. Apparently, when she was pregnant, she had some complications, and she dreaded seeing the doctor so much that her doctor put her on an anti-anxiety medication. She told me she couldn't prescribe me one, but she referred me to a psychiatrist.

My blood pressure is normal and even low normal outside the doctor's office. The lowest I've gotten it inside the doctor's office is 124/69. That time I told the nurse that I wanted my blood pressure taken last, right before being weighed, and then I asked her to talk to me. So, we had a conversation about where I was from, where she went to school, how she liked her job. We laughed and joked, I relaxed, and by the time she took my pressure, it was kind of normal, although my pulse was elevated.

Distraction and sitting for a while to calm down have helped me, but I still periodically have high blood pressure at the doctor's office. You just have to insist that the doctor take your blood pressure at the end of your appointment or that the nurse take your blood pressure last. Don't be afraid to ask for what you need. Nurses used to rush me in, weigh me, and then take my blood pressure right after - like seeing my weight isn't enough to drive my blood pressure up! :) After years of terrible anxiety, I finally couldn't take it anymore. Now they give me a chance to relax, but it doesn't always work.
 

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When my everlovin' was in practice, his nurses were briefed to allow patients to lie down for a few minutes to relax & get their wits about them if need be. It prob'ly didn't always help, and that cussed exam table is anything but comfortable, but apparently it helped a few get lower readings.

I'm a little late to the party here, but I have the worst white coat syndrome ever. My blood pressure skyrockets, I get heart palpitations, and I have trouble breathing. What's worse is that I now have anxiety about my anxiety, so I have several emotional breakdowns before every doctor's appointment. Knowing I have an appointment ruins my entire week. I have trouble sleeping, eating, and working.

Before my appointment, I sit in the waiting room with my head in my hands trying to slowly breathe myself into calm, but that never works.

I have talked to several doctors about this and only my last doctor seemed to care. Apparently, when she was pregnant, she had some complications, and she dreaded seeing the doctor so much that her doctor put her on an anti-anxiety medication. She told me she couldn't prescribe me one, but she referred me to a psychiatrist.

My blood pressure is normal and even low normal outside the doctor's office. The lowest I've gotten it inside the doctor's office is 124/69. That time I told the nurse that I wanted my blood pressure taken last, right before being weighed, and then I asked her to talk to me. So, we had a conversation about where I was from, where she went to school, how she liked her job. We laughed and joked, I relaxed, and by the time she took my pressure, it was kind of normal, although my pulse was elevated.

Distraction and sitting for a while to calm down have helped me, but I still periodically have high blood pressure at the doctor's office. You just have to insist that the doctor take your blood pressure at the end of your appointment or that the nurse take your blood pressure last. Don't be afraid to ask for what you need. Nurses used to rush me in, weigh me, and then take my blood pressure right after - like seeing my weight isn't enough to drive my blood pressure up! :) After years of terrible anxiety, I finally couldn't take it anymore. Now they give me a chance to relax, but it doesn't always work.
 

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Discussion Starter · #14 ·
What's worse is that I now have anxiety about my anxiety, so I have several emotional breakdowns before every doctor's appointment. Knowing I have an appointment ruins my entire week. I have trouble sleeping, eating, and working.

Before my appointment, I sit in the waiting room with my head in my hands trying to slowly breathe myself into calm, but that never works.
Amen to being upset about being anxious! The more they give me grief about my BP, the more I freak out about it. Once the nurse took it, told me it was too high so she wanted to take it again blah blah, lectured me while taking it, it went from 135/80 to 180/100 in 2 minutes.

For now I am avoiding the entire subject. I stopped taking my BP 2x a day because it was just driving me insane. I haven't called the doctor back with what my BP has been lately since I forced her to lower the dose because I just can't take anymore stress about it... The drama about white coat has even caused me to look for a new doctor...
 

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When my everlovin' was in practice, his nurses were briefed to allow patients to lie down for a few minutes to relax & get their wits about them if need be. It prob'ly didn't always help, and that cussed exam table is anything but comfortable, but apparently it helped a few get lower readings.
He had the right idea! I wish all doctors and nurses did that.

Daytona said:
Amen to being upset about being anxious! The more they give me grief about my BP, the more I freak out about it. Once the nurse took it, told me it was too high so she wanted to take it again blah blah, lectured me while taking it, it went from 135/80 to 180/100 in 2 minutes.

For now I am avoiding the entire subject. I stopped taking my BP 2x a day because it was just driving me insane. I haven't called the doctor back with what my BP has been lately since I forced her to lower the dose because I just can't take anymore stress about it... The drama about white coat has even caused me to look for a new doctor...
That sounds a lot like my experience. The nurses at my last clinic would lecture me disapprovingly and give me a serious look, "Oh, your blood pressure is very high." The fear of that judgment would just drive my blood pressure higher.

Shopping around for a new doctor may be a good idea. I found a lot of my doctors to be unsympathetic about the problem, even staring me down skeptically like I was lying about my blood pressure outside the office to avoid going on medication. (I'm already diabetic. Do I care at this point if I have to add another pill?) You need your doctor to be on your team, so if she's not and the situation is causing you this much stress, perhaps it's time to move onto someone else.
 

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So I have white coat syndrome. At the doctor's office my BP is 140/90 but at home it is always 120/80 - 110/60 depending on stress and time of day.

My doctor thinks that I must take BP medication because of the increased risk of stroke and heart attack for diabetics. I am taking a clonidine patch but I really don't want to be taking medicine. I infrequently experience dizziness/feintness when going from standing to sitting which indicates that my BP is low and it is quite unpleasant. I didn't run into this before taking the medicine.

When I looked up online how to deal with hypertension every talks about how to fix chronically high BP, not stress related highs. Since it is only high when I am upset, I am not sure if diet changes would be effective?

Mostly I'm wondering if anyone else has dealt with white coat and had any advice for 1) not freaking out every time BP is mentioned and 2) how to get my doctor to titrate me off of this medicine?
Sometimes my BP measures as high 130/80 at the Doc's office, but I think it's the PAIN of the blood pressure cuff. I swear those things hurt so much that it sends a surge of adrenaline and pain must suddenly spike my BP. Any other time I measure it, it's 120/70, so I know it's their painful technique. If they even mention BP meds, I tell them NO WAY!!
 

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My doctor was nice enough to let me take my BP at home, grocery store, fire department. Keep track and report back to him. As always it's fine....
He was happy with that...
 

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Be sure they use the proper cuff when taking your blood pressure. The unit I use at home has the extra large cuff, and that's what they use at doc's office too. Having the correct size cuff makes a difference in your reading.
 

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Hi Daytona,

It's so nice to see your post because my situation is exactly the same as yours when it comes to BP - even the numbers are roughly the same: 140/90 at the doctor's office and roughly 105-120/65-80 at home. Because of the high number during my office visits, my doctor is trying to get me to start taking BP medication (Lisinopril). I was only recently (2009) diagnosed with type 2 diabetes, and I've been on two other medications (a blood glucose medication and a statin) ever since. At the "young" :eek: age of 36, I am really averse to the idea of having to take yet another medication for the next 20,30,40.... years :(

So for now I plan to keep on turning my doctor down, and instead continue to monitor it at home, as well as continue exercising regularly and watching my weight and what I eat. Other than going in for my routine A1c and blood test, I'll also limit my visit to the doctor to once a year.

David
 

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Discussion Starter · #20 ·
Keep up the good fight! My husband likes to remind me that I pay the doctor to consult, but he's not the boss, I am. :D

Why don't you head over to Introduce Yourself and let us know more about yourself and say "hi".
 
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