Answer:

"White-coat syndrome" refers to the situation in which the blood pressure measured in a physician's office is consistently higher than when the patient measures it at home or at work.

Studies suggest that 10%-20% of patients may experience white-coat syndrome. The cause of the syndrome is unclear but may be a conditioning phenomenon -- the anxiety of early visits to the physician's office is "learned" and subconsciously repeated during subsequent visits. Studies suggest that for patients with white coat hypertension, the heart disease risk is between that of patients with true hypertension and patients with normal blood pressure. That is, cardiovascular risk is increased, but is not as high as someone with sustained hypertension.

In your husband's case, my recommendation would be to first confirm the white-coat effect. This is best accomplished by wearing a 24-hour ambulatory blood pressure monitor, which will periodically measure and record the blood pressure outside the physician's office. If the blood pressure is normal in this ambulatory assessment, it would be consistent with white coat syndrome. Also, ask your physician to check your home blood pressure monitor. If it is accurate, it could used to document out-of-office blood pressure levels. If white-coat hypertension is confirmed, we generally rely on the home assessments to guide therapy.

There is no evidence that treating patients with white-coat syndrome increases risk, but this possibility has not been studied at length. If your husband is having symptoms of excessively reduced blood pressure -- like light-headedness when rising from a chair, or unusual fatigue or tiredness, discuss this with his physician. - David Calhoun, MD, associate professor of medicine, Vascular Biology and Hypertension Program, University of Alabama at Birmingham