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Battling White Coat Syndrome

25K views 51 replies 22 participants last post by  thiruvelan 
#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?
 
#3 ·
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! :)
 
#4 ·
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.
 
#5 ·
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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#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!
 
#7 ·
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.
 
#10 ·
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?
 
#11 ·
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.
 
#12 ·
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.
 
#13 ·
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.
 
#16 ·
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!!
 
#17 ·
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...
 
#19 ·
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
 
#26 · (Edited)
Good for you! Do not just take what the doctors says as gospel. Think for yourself, get a second opnion.
Doctors are sometimes rewareded for gettng people on meds that they must stay on for the remainder oftheir lives.
Sure insures big pharma' retirement.
I have been able to through away my pain medicine and 2 BP meds.
There are alternatives to pill popping. Look for them.
 
#21 ·
Hello & welcome, David. Your doc is surely aware of "white coat" hypertension . . . and your in-office readings aren't off the charts anyhow. I think he should simmer down in his push for meds. You may not need a statin either, if he put you on it only because you're diabetic. That's how I got on it, and after a year, I asked to get off, and he agreed.

What diabetes meds do you take, and what kind of food regimen are you eating? As Daytona says - maybe you could click over to the Introductions board & tell us more about yourself. We're nothing if not nosey . . . ;)
 
#28 ·
Thanks! Actually I was put on a statin because at the time my cholesterol and triclycerides were also high. But you are right the doc did say that he prescribes statins to all of his diabetic patients. And now he's trying to get me on an ACE inhibitor, even as a prophylatic :(

I'm taking glipizide. I haven't read too many posts yet but I have yet to see another person taking this in the forum. Most of the posts I've come across still use the more common metformin. I'm not really not any special diet: I immediately stopped drinking sodas and juices right after my diagnosis. I have also cut down quite a bit on carbs, especially rice and related items (as a Chinese they used to constitute a significant part of my diet :p), and have started eating a lot more fruites and vegetables. and I finally start exercising regularly about six months ago.
 
#22 ·
A story about white coat syndrome . . .

I don't usually have it, but there was this one time at band camp . . . :p No, not at band camp, it was when I was on a business trip and I heated up water for tea in the microwave and then, when I dropped in the tea bag, the water exploded in my face. Literally. Like a geyser.

So I start running cold water on the scald on my face while I fumble for the phone to call the front desk for ice. They were all very nice, very concerned, brought ice, called a cab, and I made my way to the ER.

When I checked in, my blood pressure was a nice and normal 120 over 80. But after 6 hours of being ignored as I sat in a chair across from the public restroom with water seeping under the door and onto my shoes, my blood pressure had shot up to 150 over 90, or some such reading. And Nurse Ratched, who finally came to dress the scald and sign me out, had a passive-aggressive field day acting oh-so-concerned about my high blood pressure.

I wanted to scream. But I managed to strangle that down and tell her that if she'd had the brains to check the goshdarned chart, she'd've seen it was sitting for 6 hours in a world of hurt in the stupidpoopy hospital that had caused it to go so high, and keep your incompetent hands off me and give me those dang papers to sign right-freaking-now so I can get the heck out of here and away from the imbeciles staffing this clearly second-rate hospital. Only I probably didn't use "goshdarned" and "stupidpoopy" and "dang" and "freaking" and "heck."

So yeah. I suppose the takeaway message is that white coat syndrome comes in different shapes and sizes. Or maybe it's that the white coats (and caps) shouldn't ignore an otherwise nice lady with a scalded face. Or maybe it's that I'm not as nice of a lady as I think I am. :eek:
 
#24 · (Edited)
Instead of forcing pills on people, I wish they would do more research into WHY some people can be stressed and keep a normal BP and others can't. I believe there must be an underlying cause, like a hormone imbalance.

Normally everything looks okay but when during a stress response, adrenal hormones surge up and so should inhibitory hormones, like GABA. If your inhibitory response is weak or slow, or maybe even something else, then as a side-effect your BP rises.

When I started taking GABA, it seemed to help with my physical response to anxiety. Lately I have had a much better chance of getting "non-critical" BP #'s at the doctors office, e.g. 150/85 instead of over 200. this is just my pet theory but if something like this turns out to be the cause, then taking BP meds aren't addressing the root problem. It will make one symptom lessen but the hormonal imbalance is still there, wreaking havoc while the doctor is paid and happy.

*head* *bang* *on* *desk*

Edit: Turns out I'm not crazy, here's one study looking at just this connection!

Effects of six antihypertensive drugs on blood pressure and hypothalamic GABA content in spontaneously hypertensive rats
 
#27 ·
I don't have high BP, but everytime I go in it usually comes out high. He usually waits 15 mintues and it has gone down. When I test at home it is always 111/75 or lower but in the office it will be 130+/80. I've even tried deep breathing exercises in the waiting room but it doesn't help. Now the insurance company has me listed as having high BP on my pre exhisting conditions. Now I will accept the diabetes but not the high BP. I agree they try to push way too many pills on us. I was on a statin which totally wrecked my body, so I am trying to stay on the least amount of meds as possible.
 
#30 · (Edited by Moderator)
I can't remember if I said this before or not. :) My endo officially threw up her hands and gave up on figuring out high blood pressure (it was 180 / 100 at the last visit).

She referred me to a cardiologist saying "A 29 year old should never have blood pressure like yours". I stressed that I would refuse to work with a doctor whose only answer was to push drugs so we'll see if the one she referred me to will be any better than all the ones before her.

If she has nothing original to say, and can't articulate a cause or hypothesis for my white coat, I am officially saying " I don't give a **** anymore". I would rather die from a heart attack at 30 than continue to let this cause me anymore stress. I think the stress is worse for me anyway that occasional highs.

So wish me luck and I'll report back tomorrow night with how it goes!
 
#31 ·
So it was a bit of a mixed bag. She was very nice, so nice in fact that my blood pressure in the office was 118/74!

She is taking me off the blood pressure medication to get a feel for what my BP is really like without meds before making any decisions. Since I wanted off of it anyway, I was pretty happy with that. I'm also having my lipids redone along with c-reative protein and an echocardiogram to check for any damage.

She was quite impressed with my weight loss and blood sugar control, asking questions about my diet. She wanted to "report" the dieticians who told me to eat 250g of carbs a day. I told her they were her own hospital's dieticians and go right ahead! :D

The only thing that gave me pause was that I think she's a statin prescribing, low-fat, low-salt gal. I avoiding saying exactly what I eat other than "gluten-free, no processed foods". She specifically recommended the DASH diet to me but I'm not looking to change what obviously works so well for me.

I see her again next week to see how the tests turn out. So we'll see.
 
#34 ·
Garlic?

I scanned this whole thread pretty close and did not see a word about Garlic. As somebody that's studied up abit on herbs (related to my work) I know that Garlic is just given the highest respected for being effective (in the Herbal world). Also, there is garlic, and there's GARLIC - if you want to get more serious than popping a few tasteless capsules. Folks I know and respect grind a fresh clove and mash it before eating it. A women I did volunteer community gardening with (she ran the show) actually grew a special crop from a seed source she could talk about for an hour easy. I was too busy weeding - BUT garlic is just such a great food / medicine - it actually, somehow, can adjust low BP up, or high BP down - as best I understand it, I take it as one of only two but don't have BP issues so this is second hand info.

(Think of the ads big pharma would run if they had anything that worked both ways?! This has been studied in depth, I believe, its not one of those supplement over-reach things I can assure you, however, of course, mileage can vary.)

Just do your own due diligence and see if it helps, it seems to fit what I understood to be your goal - staying away from the hard stuff. If you can't find a study I know I've seen some, and I've a got a pretty serious library / and am a member of ABC and they have a online knowledgebase on this)

-george
 
#35 ·
I scanned this whole thread pretty close and did not see a word about Garlic. As somebody that's studied up abit on herbs (related to my work) I know that Garlic is just given the highest respected for being effective (in the Herbal world). Also, there is garlic, and there's GARLIC - if you want to get more serious than popping a few tasteless capsules. Folks I know and respect grind a fresh clove and mash it before eating it. A women I did volunteer community gardening with (she ran the show) actually grew a special crop from a seed source she could talk about for an hour easy. I was too busy weeding - BUT garlic is just such a great food / medicine - it actually, somehow, can adjust low BP up, or high BP down - as best I understand it, I take it as one of only two but don't have BP issues so this is second hand info.

(Think of the ads big pharma would run if they had anything that worked both ways?! This has been studied in depth, I believe, its not one of those supplement over-reach things I can assure you, however, of course, mileage can vary.)

Just do your own due diligence and see if it helps, it seems to fit what I understood to be your goal - staying away from the hard stuff. If you can't find a study I know I've seen some, and I've a got a pretty serious library / and am a member of ABC and they have a online knowledgebase on this)

-george
Is the benefit supposed to be that it adjusts someone's blood pressure down/up or that it corrects an adrenal imbalance? Because I have perfectly fine blood pressure 99% of the time, it's only when I have an fear response that it shoots up. The cardiologist confirmed what I have suspected which is that it's an adrenal imbalance, I don't make enough of the hormones that should be secreted along with cortisol and adrenaline to counteract their effect.

I have had mild improvement with GABA, 750mg a day. It seems to blunt my stress response but isn't a cure all. Though I have not tried the higher doses that MCS and others here have attempted.
 
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