Q: My internist has labeled me hypertensive and I am on Diovan, amlodipine and propranolol. My question is this: my pressures are measured in his office immediately upon sitting down with his nurse while she is talking to me. I have found that my pressures at home are 20 points lower on the systolic and diastolic side and normal when I sit for a few minutes before taking the reading. I am told that having a labile reading still categorizes me as hypertensive and the lower the better, therefore meds are still warranted. Do you agree with this philosophy?
A: Blood pressure should be taken correctly, especially in a doctor’s office. The current recommendation is to let a person sit quietly for a few minutes before taking blood pressure. Ask to have it taken correctly on your next visit. Keep in mind you are on three different blood pressure medicines. You get lower or normal readings at home. This means the medicine is working but you still have the condition known as hypertension. I am not sure how your doctor is using the term labile hypertension. All blood pressure is labile, it goes up and down
throughout the day.
(27 votes, average: 3.56 out of 5)
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my blood pressure is always lower at home. one reason besides siting in his office before they take my pressure is its a fact your will be higher at the doctors office because of the antispation
i READ AN ARTICLE STARTED TAKING HALF OF MEDS AT BEDTIME AND ITS LOWER NOW AT HOME AND AT DOCS OFFICE HAS BEEN 190 OVER 100 AT OFFICE NOW 150,S OVER 94 AND 130 OVER 73 AT HOME
My blood pressure is always high when taken at the Dr. office. I now journal my blood pressure at home, taken at different times throughout the day. I bring this to my Dr. so she can see the lower consistency at home vs. the higher reading at her office.
My blood pressure was up in the 150’s over 90’s and by simply changing my diet, it is now down around 120 over 75
Please tell me what the “simple” diet changes are/were that you made. I could use the help.
Thanks
I, too, have great success when I make dietary changes. If I avoid anything containing simple carbohydrates such as white or even whole wheat flour,rice and sugar, my blood pressure will drop from low hypertensive (140+/80+ and occasionally higher) to excellent (like 117/70)within several days. It also seems to help to eat smaller meals and not eat until you are full. Vegetable, fruit and bean carbs work fine for me. Though I like brown rice and sweet potatoes, I have to eat them only occasionally. When I go back to eating the simple carbs, my blood pressure rises again.
I probably am insulin resistant or something because I cannot lose weight or control blood pressure without eating as I mentioned. I know this doesn’t work for everyone.
Diet is the best medicine. I stopped consuming simpe carbs (no white flour, sugar, high fructose corn syrup, agave syrup, maple syrup, etc.) and make 90% of my intake plant foods and 10% fish, lean meat. I also eliminated all oils and dairy. BP is down from 200+ before meds to the present 119/64 without meds. Meds were discontinued about one month ago. All of this happened within 6 months.
I’ve done all that too Jason,only eat salads,tuna,chicken and fruit.Mine has gone down too but not enough yet.You encourage me.
The Higher BP reading in your Dr. Office is definately due to anticipation of the reading . My Dr. calls it “white coat syndrome.
that happens to me also. i have my own bp machine at home which reads pretty much normal but once i get to the dr’s office it reads high. i even took my machine to the dr’s office and it read high again.
I am totally agree which exactly happened to me aswell
My dentist has a new policy to take a patients blood pressure (seniors)does any dental work.I was laid back in the chair with am feet up and he pops one of those wrist blood pressure on me. naturally my blood pressure was high and he tells me I need more medicine. I think the dentist should do what they do best and leave the blood pressure alone. The following week i went to my doctor for 6 months check up. the nurse forgot to do the blood pressure. Whhen I reminded the doctor he didn’t do it either.They did give me a paper to have my blood work done however the doctor forgot to sign it and Care First would’nt do the blood work.
The “white coat syndrome” is well-documented and often commented on in these replies/comments over the years. My blood pressure will often be 100/60 at home consistently but in the office 195/100. For some reason, nurses do not seem to know they should 1) let the patient sit calmly for five minutes,2) neither talk or let the patient talk during readings, 3) take the blood pressure 3 times times (throw out the first reading and average the last two), 4) keep the patient’s arm elevated to heart-height while taking readings.
So yes, keep the chart at home and take in the list when you go to the physician’s office. If he/she has any sense, the at home readings should be the truer measure of your actual BP. Still, very high in-office readings might be a concern.
A prestigious medical center investigating the reasons of why I had such a HBP came to the conclusion I had a good case of white coat syndrome ( not that it was the only reason for HBP) after that they quit taking my BP at every opportunity and the doctors would let a particular nurse who was very patient and polite and had a calming personality take my BP, she would give me time to relax and would ask me when I felt like taking my BP, it would come down up to 20+ points in 15 minutes by that simple action.
I had a dentist who never made an issue about my BP, he treated me for years but I decided to try new a dentist (big mistake) in an effort to find a cheaper doctor to repair a broken tooth. At this new doctor’s office in the questionnaire I put down I have HBP, did I opened a can of worms! Next I am laying on the chair with my legs up, strong lights on my face blinding me, 2 or 3 assistants around me, rolling in this huge machine to check my BP, the doc is standing looking over me nodding his head from side to side while this machine was humming and beeping, I felt like I was being readied for a KGB torture session, concerned looks all around, dammed is that bad, will I live? Lets try again said the doc, it cant be! Wow is worst! Did it ever occurred to this AH that laying on a dentist chair upside down on the verge of having his head drilled while looking at syringes with 3 inches long needles surrounded by concerned looking strangers is not a particularly relaxing time? He said he could not work on me, get my BP down and come back, (sure!), on my way out they charged me 100$. Two more episodes like this with other docs and by now a year went by and now I needed a root canal, I went to this female specialist on root canal, I told her about my HBP as before because I thought is was very important since every one of them made such a big drama out of it, Oh really! after a while her assistant found a little portable BP reader, hmm a little high, what are we going to do? Honey we are going to fix that baby in no time, you just nervous, relax, you want a little pill to help you relax? Next she said finish, really! that’s all? Yeap, go to your dentist and have a cap put on it, I left with a grin ear to ear.
Years of that kind of crap with different doctors starting with the first one who diagnosed me with “malignant HBP..?”…… Will put the fear in you of that little machine and the man behind it.
I know the feeling of the White Coat Syndrome. What I’ve done the past couple of years it bring a report I’ve taking over the course of the year to show my doctor my monthly average readings on a spreadsheet. I take a reading in the morning around 10:30am that’s about 3 hours after I’ve taken my Lisinoprol, and then in the afternoon around 3:30pm. I do this on a daily basis,and put this information onto to a weekly spreadsheet. At the end of the week I average my morning reading for Systolic, and Diastolic,and heart rate. I do the same for the afternoon reading. Usually the afternoon is higher because the Lisinoprol has worn off. I then gather each weekly average, and do one monthly average for the morning and afternoon. That’s placed onto another spreadsheet. So when it comes time for me to get my BP checked at the doctors, and it’s high, I pull out the monthly average printout, and show it to doc. Not much he can say when there is a large difference in what the reading is at his office, and my monthly and 1 yearly average.
That’s the way to do it. They can’t argue with fact. I do the same thing now so they can’t accuse me of having severe hypertension. These doctors are complete idiots if they can’t accurately diagnose white coat hypertension. For god’s sake, I’m not an MD and I can figure that out! A recent article stated that over 30% of hypertension is misdiagnosed and is “fake” “white coat hypertension”
It is incorrect technique for the nurse to interview you and ask questions while taking the blood pressure. When a nurse does this, I tell her she’ll get an inaccurate reading if she makes me talk, think, or jump through hoops…
I’m glad I’m not the only one with this “white coat” problem. My BP soars in the doctors office even on meds. Normally 115/70 at home then as high as 180/88 at the doctors office. That tells me these meds don’t prevent white coat syndrome. The question is: What does? Perhaps it’s a dietary change which is what I’m trying now. I agree with others here that it’s best to keep a log to show your doctor. Then we he says “you’re still running high today” you tell him “Why am I always normal at home?” You figure this out doc, that’s what I’m paying you for. I don’t need an MD degree to know something isn’t working here. I agree that the anticipation and stress associated with the doctor appt has a huge impact. Play detective, change one variable at a time and see if it helps.
I also get this White Coat Syndrome at the doctor’s office although I think that the main culprit for me is the six miles of driving I have to do in the traffic to the doctor’s office. The anticipation of the doctor’s appointment and having my blood pressure checked adds to it too but not as much as driving to the doctor’s appointment does. Having a long walk to the doctor’s office from the parking lot is a factor too and that is why the in-checking nurse and doctor should allow you to relax for five minutes or so before they check your pressure, longer, if possible. Also, if I wait to take care my personal cleanliness; shaving, showering, etc., on the same day immediately before my appointment and have to hurry doing it, this will also add to my hypertension. Works out better to take care of these things the day or evening before, for me anyway. My physician places much importance on my record of blood pressure readings which are taken at home.
Blood pressure is usually recorded while you are seated. The right arm is usually used, but it is best to measure the blood pressure in both arms. The room should be at a comfortable temperature. The equipment should not be cold but should be room temp. The blood pressure cuff should the the correct size for your arm-if too large, it will lower the reading; if too small, it will raise the reading. The arm should be held at the patient’s heart level by the person measuring or the patient’s are should be resting on something at heart level. The blood pressure should be measured 3 times. Wait for at least 5 minutes in between readings. Some physicians take the blood pressure in three positions: standing, seated, and lying down. I beleive the new normal is 120/80 or below. If you have a thin, healthy young woman, it is not unusual for her seated, restingblood pressure to be 90/60 or thereabout. All blood pressure fluctuates from arm to arm and minute to minute. However, if the fluctuation is extreme, your blood pressure is considered to be labile as the arteries are opening and closing to extremes. Stable, well controlled blood pressure should not fluctuate too much. I am a Registered Medical Assistant with 30 years of experience measuring blood pressure.
What causes this large fluctuation in blood pressure? I have this problem and it is always high in doctors office but normal at home. They put me on medication and then it goes too low at home and still higher than normal in doctors office.
I am a senior citizen who has gone to the same dentist for about 20 years. They started this new protocol about bloodpressure which is high for me in the dr.’s office. I reminded the dentist that I do not take anything for pain and they said (after consulting with the owner), o.k. we will work on you. No more bloodpressure measures and I get the work done.
Doctors are now getting very suspicious in regards to so called “white coat hypertension” thinking it is a precursor to essential hypertension. From what I’ve read it’s the sress that causes the arteries to constrict which may indicate some vascular resistance in the arteries, although they still don’t seem to have a clue as to how to deal with it.
Why don’t you all ask for a 24 hour blood pressure monitor,works while you are asleep etc