How Common Is White Coat Syndrome?

By Wayne Persky

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​A search of the Internet shows that there has been a significant amount of research published regarding the prevalence of white coat syndrome (WCS), also known as white coat hypertension. This condition refers to the phenomenon where patients exhibit elevated blood pressure readings in a clinical setting, such as a doctor's office, but have normal blood pressure readings in other settings, such as at home.

It's likely that many patients are misdiagnosed with hypertension.

Clinicians typically would rather treat hypertension than not, since hypertension is known to lead to many health problems. They probably view it as a "safe" diagnosis, even if incorrect, since they consider the treatment to be safe, even if the patient doesn't actually have hypertension. Therefore many clinicians usually don't make any attempt to rule out white coat syndrome.

But white coat syndrome is a common issue.

Research indicates that the prevalence of white coat syndrome can vary widely, with estimates ranging from 15% to 40% of patients with elevated blood pressure readings in clinical settings (Mancia, Facchetti, Bombelli, Cuspidi, and Grassi, 2021).1 Factors contributing to the prevalence of WCS include anxiety, the patient's medical history, and the specific context of the medical visit.

White coat syndrome tends to be more prevalent in younger individuals and those with higher levels of anxiety. It's also observed across various demographics, but the specific prevalence can vary based on factors such as age, sex, and overall health.

Alternate methods can be used for monitoring blood pressure.

Several studies have utilized ambulatory blood pressure monitoring (ABPM) to assess blood pressure variations in patients and have found that a notable percentage of individuals diagnosed with hypertension in a clinical setting may actually have normal blood pressure when measured outside of medical offices.

When suspected, white coat syndrome should be ruled out by further testing.

White coat syndrome can obviously complicate the diagnosis of hypertension, as it may lead to misclassification of individuals as hypertensive when they are not, and that never looks good on a patient's health record. Accurate diagnosis often requires repeated measurements or alternative monitoring methods. This condition highlights the impact of psychological factors on physical health, emphasizing the need for healthcare providers to consider patients' mental states (with regard to anxiety) during assessments.

While it's suspected that white coat syndrome may be associated with cardiovascular issues, there are currently no research data to verify any cause/effect relationship. It's likely that if there is an association, is primarily due to the stressful effects of anxiety, since chronic stress is known to cause inflammation. And published research shows that inflammation (especially IL:-6) is associated with systolic blood pressure (Chae, Lee, Rifai, and Ridker, 2001).2

References:

1, Mancia, G., Facchetti, R., Bombelli, M., Cuspidi, C., and Grassi, G. (2021). White-Coat Hypertension: Pathophysiological and Clinical Aspects: Excellence Award for Hypertension Research 2020. Hypertension, 78(6), 1677–1688. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC9634724/

2. Chae, C. U., Lee, R. T., Rifai, N., and Ridker, P. M. (2001). Blood Pressure and Inflammation in Apparently Healthy Men. Hypertension, 38(3). Retrieved from https://www.ahajournals.org/doi/10.1161/01.HYP.38.3.399