Hypertension is a condition where blood pressure is above normal, namely above 120/80 mm Hg.1 Every May 17, we commemorate World Hypertension Day to raise awareness of the importance of preventing and controlling blood pressure because hypertension is a major risk factor that can develop cardiovascular disease. In 2025, World Hypertension Day carries the theme "Measure your blood pressure accurately, control it, live longer". In relation to this theme, one of the blood pressure disorders that requires accurate measurement and proper treatment to obtain a longer life is white coat hypertension.
What is White Coat Hypertension and what causes it?
White coat hypertension is a condition in which a person's blood pressure increases while in a health facility or undergoing a medical examination, but returns to normal when at home or in a non-medical setting. This condition is usually caused by anxiety or stress when facing a medical situation, such as seeing a doctor or undergoing an examination.1
Although often considered mild, white coat hypertension should not be ignored. Research shows that this condition can increase the risk of cardiovascular diseases such as stroke, heart attack, and heart failure.1 Unlike essential hypertension that occurs consistently in various situations, white coat hypertension only appears in a medical context. A person is said to have this condition if their blood pressure is ≥140/90 mmHg when in a health facility, but <130/80 mmHg when measured outside a medical facility without the influence of drugs.3,4
Risk Factors for White Coat Hypertension
Some factors that can increase a person's risk of experiencing white coat hypertension include:2.4
1. Women, especially those over 50 years of age
2. Individuals with anxiety or psychological disorders
3. Recently diagnosed with hypertension
4. Obesity
5. Pregnant women
Diagnosis of White Coat Hypertension
Diagnosis of white coat hypertension requires a careful approach, including:4
- Blood pressure measurement at a health facility on at least three separate visits with results ≥140/90 mmHg.
- Blood pressure measurement outside of health facilities, either through 24-hour Ambulatory Blood Pressure Monitoring (ABPM) or self-measurement at home, with results <135/85 mmHg on two different examinations.
- Absence of target organ damage which is usually caused by chronic hypertension.
ABPM is the gold standard for differentiating white coat hypertension from essential hypertension, although it is not always available in all healthcare facilities.
White Coat Hypertension Treatment
Treatment for this condition includes:2,3
1. Regular blood pressure monitoring to confirm the diagnosis and monitor the progress of the condition.
2. Lifestyle changes, such as increasing physical activity (regular aerobic exercise), losing weight, reducing salt intake, and avoiding foods high in saturated fat.
3. Administration of antihypertensive drugs, only if there is high cardiovascular risk or evidence of target organ damage.
4. Improve communication between patients and medical personnel to reduce anxiety during examinations.
White coat hypertension is a condition that needs to be considered because it can be the beginning of persistent hypertension and increase the risk of cardiovascular complications. If you experience a spike in blood pressure during a medical examination, consult a doctor for further evaluation. Self-monitoring of blood pressure and healthy lifestyle changes are highly recommended to prevent the development of the disease.
References:
1. Kimberlly Holland. Everything You Should Know About White Coat Syndrome. Healthline. Last reviewed: December 21, 2023. Available at: https://www.healthline.com/health/white-coat-syndrome
2. Cleveland Clinic staf. White Coat Syndrome. Cleveleand Clinic. Last reviewed: March 8, 2022. Available at: https://my.clevelandclinic.org/health/diseases/23989-white-coat-syndrome
3. Sienny Agustin. Hipertensi Jas Putih, Peningkatan Tekanan Darah Saat Bertemu Dokter. Last reviewed: March 11, 2024. Available at: https://www.alodokter.com/hipertensi-jas-putih-peningkatan-tekanan-darah-saat-bertemu-dokter
4. Stanley S. Franklin, dkk. 2013. White-Coat Hypertension: New Insights From Recent Studies. Hypertension. 62(6): 982-987