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My Blood Pressure Is Only High at the Doctor's Office: Do I Need Treatment?

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Updated June 18, 2014

Question: My Blood Pressure Is Only High at the Doctor's Office: Do I Need Treatment?
Answer: Whitecoat hypertension is not usually treated with medicine.

This is because studies have shown that the problem is both common (up to 20 percent of the population is affected)1 and tends to resolve on it's own. That is, most people lose this temporarily elevated blood pressure by their third visit to the doctor.2Sometimes it takes a little longer for this issue to resolve, so patients are usually given six visits3 before doctors start thinking about the possibility of beginning treatment.

Early research suggested that people with whitecoat hypertension were not at any increased risk of cardiovascular mortality (death from heart or circulation problems) compared to people with normal blood pressure.4

More recent studies have shown that people with whitecoat hypertension do face some additional risks, including:

  • Increased risk of stroke5
  • Higher liklihood of developing persistent high blood pressure6
  • Certain negative cardiovascular traits associated with high blood pressure7

Despite this increased risk profile, the fact remains that most people with whitecoat hypertension spontaneously improve. Doctors should watch blood pressure carefully in these circumstances, and should discuss lifestyle changes as a way to improve blood pressure control. Additionally, a home blood pressure monitor may be used to verify that the elevation really does occur only in the doctor's office. However, formal drug therapy is typically not indicated unless the elevated blood pressure persists past the sixth office visit.

Sources 1Pickering, et al., How Common is Whitecoat Hypertension? JAMA, 259(2)225-8, 1988.
2Chobanian, et al., The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report. JAMA, 289(19)2560-72, 2003.
3Watson, et al., Variation in cuff blood pressure in untreated outpatients with mild hypertension: Implications for initiating antihypertensive treatment.Journal of Hypertension, 5(2)207-11, 1987.
4Khattar, et al., Cardiovascular outcome in white-coat versus sustained mild hypertension: a 10-year follow-up study. Circulation, 98(18)1892-7, 1998.
5Verdecchia, et al., Short and Longterm Incidence of Stroke in Whitecoast Hypertension. Hypertension, 45(2)203-8, 2005.
6Bidlingmeyer, et al., Isolated Office Hypertension: A Prehypertensive State? Journal of Hypertension, 14(3)327-32, 1996.
7Palatini, et al., Target Organ Damage in Stage I Hypertensive Subjects with Whitecoat and Sustained Hypertension: Results from the HARVEST Study. Hypertension, 31(1)57-63, 1998.

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