What Causes White Coat Syndrome and How to Overcome It

If your blood pressure seems higher at the doctor’s office than at home, you may have white coat syndrome (also called white coat hypertension). This condition, which affects about 1 in 5 people, causes a temporary increase in blood pressure due to stress or anxiety in medical settings (*Harvard Health Publishing*).

While it’s usually harmless, white coat syndrome can be difficult to diagnose because it mimics (chronic high blood pressure). And in some cases, it may signal a higher risk of heart problems.

Here’s what causes white coat syndrome, why it happens, and how to manage your nerves at medical appointments.

What Is White Coat Syndrome?

"White coat syndrome is the term used to describe a spike in blood pressure that occurs only at a doctor's office, due to anxiety and fear," says Jodie Skillicorn, DO, a holistic psychiatrist.

Unlike true hypertension, white coat syndrome means your blood pressure is normal in everyday life but rises when you’re in a medical setting.

What’s Considered Normal Blood Pressure?

According to the Cleveland Clinic, a healthy blood pressure is:

• Less than 120 mm Hg (systolic, the top number)

• Less than 80 mm Hg (diastolic, the bottom number)

If your readings are consistently above this only at the doctor’s office, you may have white coat syndrome.

What Causes White Coat Syndrome?  

White coat syndrome is triggered by your body’s “fight or flight” response, which causes:

• A surge of stress hormones (like cortisol and adrenaline)

• Increased heart rate

• Constricted blood vessels

• A temporary rise in blood pressure

According to Dr. Skillicorn, many people experience this because of:

• Past negative medical experiences

• Fear of bad news or judgment

• Feeling intimidated by doctors

In some cases, just anticipating a high reading can create a cycle of anxiety that keeps your blood pressure elevated.

Who’s Most at Risk?

Certain groups are more likely to experience white coat syndrome, including:

• People with existing hypertension (*Cleveland Clinic* estimates 15-30% of those with high blood pressure also have white coat syndrome.)

• People with anxiety (especially if they feel rushed or judged by doctors)

• Adults over 50, who tend to visit doctors more frequently

• Women, who experience anxiety disorders at higher rates (*Anxiety & Depression Association of America*)

• People with obesity, due to weight stigma in healthcare

Is White Coat Syndrome Dangerous?

White coat syndrome is not inherently dangerous, but it can sometimes progress to chronic hypertension.

According to a 2019 meta-analysis in the Annals of Internal Medicine, people with untreated white coat syndrome had a 36% higher risk of heart attack, stroke, and cardiovascular disease over time.

How to Manage and Treat White Coat Syndrome

If your blood pressure is only high in medical settings, you may not need medication, but lifestyle changes can help.

1. Practice Deep Breathing

Slow, controlled breathing activates the body’s relaxation response, helping lower blood pressure.

Try diaphragmatic breathing before and during your appointment:

1. Sit comfortably and place one hand on your chest and the other on your belly.

2. Inhale deeply through your nose, expanding your belly (not your chest).

3. Exhale slowly through pursed lips.

4. Repeat for a few minutes before your blood pressure is taken.

2. Ask for a Second Blood Pressure Reading

Since blood pressure is often measured at the start of an appointment (when you’re most nervous), ask your provider to retake it at the end when you’re more relaxed.

"Many nurses will agree the second reading tends to be more accurate," says Dr. Skillicorn.

3. Exercise Regularly

Staying active lowers stress and improves blood pressure regulation. Mind-body exercises like:

• Yoga and qigong help reduce stress reactivity.

• Cardio exercise (walking, swimming, cycling) improves circulation and heart health.

4. Try a Heart-Healthy Diet

The Mediterranean diet rich in fruits, vegetables, whole grains, and healthy fats has been shown to reduce blood pressure and lower the risk of heart disease (*Harvard Health Publishing*).

5. Monitor Your Blood Pressure at Home

Checking your blood pressure in a relaxed environment can help determine if you truly have hypertension.

• Use a home blood pressure monitor or check it at a pharmacy station.

• Take readings at different times of the day to get a more accurate picture.

6. Choose a Supportive Doctor

A calm and empathetic healthcare provider can make a huge difference. If your current doctor doesn’t acknowledge white coat syndrome, consider switching to one who understands your concerns.

7. Speak With a Therapist

If your anxiety about medical settings is overwhelming, talk therapy can help. Cognitive behavioral therapy (CBT) can:

• Reduce doctor-related fears

• Help reframe negative thoughts about medical visits

• Provide coping strategies for managing stress

The Bottom Line

White coat syndrome is common and not immediately harmful, but it’s worth monitoring. Managing stress, exercising regularly, and tracking your blood pressure at home can help you stay in control.

If your blood pressure remains high in other settings, your doctor may evaluate you for true hypertension and recommend treatment.

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