White coat syndrome

Quite often, during an examination in a doctor’s office, patients exhibit white coat syndrome when measuring their blood pressure: in a medical facility, it jumps, although the patient does not complain of high blood pressure, does not have any hypertensive symptoms, and, moreover, his blood pressure level in a normal environment is normal…

Epidemiology

According to the results of studies conducted in foreign clinics, white coat syndrome occurs in 70-73% of patients diagnosed with arterial hypertension.

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Causes of white coat syndrome

If a person goes to see a doctor, it means that there are health problems that worry him. Most people associate hospitals and clinics with illness. And doctors themselves explain the causes of white coat syndrome by excitement and anxiety (even when not clearly manifested), an involuntary state of tension and anxiety when visiting medical institutions. In general, this situation is close to stressful: patients are embarrassed by exposure, afraid of possible painful procedures and a bad diagnosis.

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Risk factors

All experts note such risk factors for the development of this syndrome as age and excess weight; some add to this list excess cholesterol in the blood, cardiopathy (in particular, cardiac ischemia), and a history of diabetes.

There is an opinion that even a temporary increase in blood pressure, that is, the white coat syndrome when measuring pressure, can indicate an increased threat to health.

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Pathogenesis

The pathogenesis of this syndrome is directly related to humoral and vegetative neuroregulation of the vascular system tone. At the slightest stress (and for many, going to the doctor is close to iatrophobia), the synthesis of the pituitary hormone corticotropin (ACTH) increases. Corticotropin stimulates the production of catecholamines - hormones-mediators of adrenaline, noradrenaline and dopamine, as well as the hormone of the adrenal cortex cortisol. And then - due to the vasoconstrictor effect of all the listed hormones - a narrowing of blood vessels occurs, resulting in an increase in blood pressure.

And since white coat syndrome usually manifests itself at every visit to the doctor, this indicates that it represents a specific psychosomatic response to a specific situation.

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Symptoms of white coat syndrome

Moreover, even patients taking antihypertensive drugs on a regular basis may show symptoms of white coat syndrome: an increase in blood pressure when it is measured.

And more often than not, the systolic (upper) pressure is elevated above the norm (that is, not 110-120, but 140-150 mm Hg) than the diastolic pressure.

This syndrome is observed in 32-35% of people who come to a medical institution without problems with blood pressure. At the same time, arterial hypertension is actually detected in 15% of patients. However, in almost 20% of patients, this syndrome is mistaken for hypertension (refractory hypertension) - with the prescription of drugs to stabilize blood pressure.

White Coat Syndrome During Pregnancy

A common phenomenon and white coat syndrome during pregnancy, when all body systems function in an altered mode. According to some data, the overall prevalence of this syndrome during pregnancy is about 32%. In half of expectant mothers, the syndrome persists throughout gestation and does not affect their condition in any way.

However, it should be borne in mind that almost 40% of pregnant women experience a true increase in blood pressure (benign gestational hypertension), which, as the pregnancy progresses, can result in late toxicosis of pregnancy with very high blood pressure.

According to WHO statistics, approximately 8% of pregnant women face a more serious problem – preeclampsia, which can progress to eclampsia, which threatens the life of the mother and fetus.

Complications and consequences

The consequences and complications of this syndrome are the development of hypertension and cardiac diseases. Those whose blood pressure readings rise higher are at higher risk. In addition, patients with white coat syndrome have a 1.9-fold increased risk of developing cardiovascular diseases associated with a fatal outcome.

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Diagnostics of white coat syndrome

Since the only symptom of white coat syndrome is visible on the tonometer scale when measuring blood pressure, this syndrome cannot be diagnosed during a standard visit to the doctor. As practice shows, for the diagnosis and treatment of arterial hypertension, one-time blood pressure measurements in the doctor's office are too often erroneous.

The syndrome can be detected by instrumental diagnostics – automated measurement of arterial pressure for 15-20 minutes in a clinical setting. Or 24-hour ambulatory blood pressure monitoring (ABPM), which is the diagnostic test of choice.

Thus, the diagnosis of white coat syndrome using ambulatory blood pressure monitoring, as well as its use as a confirmatory test when examining patients with suspected hypertension, according to experts from the British National Institute of Health, is the most accurate and cost-effective option for clinical diagnosis.

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Differential diagnosis

Self-monitoring of daily blood pressure using various portable electronic devices is increasingly used for these purposes. Thus, targeted monitoring of blood pressure in a normal everyday environment – more convenient and less expensive – ensures differential diagnostics of white coat syndrome from chronic hypertension.

Treatment of white coat syndrome

Today, the diagnosis and treatment of white coat syndrome are controversial in the medical community, as there is still no convincing evidence that a temporary increase in blood pressure during a doctor's visit has a negative impact on health.

It is generally accepted that this syndrome does not require any treatment, that is, it is better to avoid unnecessary pharmaceutical drugs to reduce blood pressure, since their use can lead to vascular hypotension.

Prevention

Prevention of possible development of hypertension will not hurt. First of all, these are changes in lifestyle: getting rid of excess weight, systematic physical exercise, giving up alcohol and smoking, a diet with limited salt and sodium - see Diet for high blood pressure

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Forecast

Doctors associate the prognosis regarding the development of negative consequences that white coat syndrome may lead to with the state of the central nervous system, endocrine and cardiovascular systems, kidneys, as well as the presence of genetic factors that lead to various disorders of vasoconstriction and vasodilation.

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