How do docs treat "white coat hypertension"?

Questions on how we spend our money and our time - consumer goods and services, home and vehicle, leisure and recreational activities
Locked
Topic Author
davebo
Posts: 840
Joined: Wed Dec 17, 2008 12:02 am

How do docs treat "white coat hypertension"?

Post by davebo » Thu Feb 15, 2018 4:33 pm

I have always kept an eye on my blood pressure since both my dad and brother have taken medications for quite a long time. I have an Omron home monitor that I use pretty much everyday to check my BP and can sit down and get a reading of 110/72 to 120/78 (on average). I'll also periodically check it at the drugstores and it's always the same. My diet is very clean...fruits, veggies, water, lean meats, nuts, etc and basically no processed foods.

Last year, I went into the Emergency Care with a broken arm. I was really nervous and also had just drank a lot of caffeine, so my BP was high (140/85 or so). They tried taking it a couple more times, but it really didn't budge much....if anything it got worse as I started worrying. Now everytime I go into a setting where someone else is taking my BP, I start to feel my heart beat quicken and I can feel my pressure rising. I think I can feel my pressure rising and those single experiences are always my "high points".

I'm not looking for Medical advice, but just curious how your docs have treated this in the past. Do you bring your home monitor in and show them that it's normal? I'm 40 years old and all my other measurements are fine. 34" waist, normal BMI, Cholesterol is 165 and LDL and HDL are both in good ranges, fasting blood glucose is low 80's.

User avatar
eye.surgeon
Posts: 456
Joined: Wed Apr 05, 2017 1:19 pm
Location: California

Re: How do docs treat "white coat hypertension"?

Post by eye.surgeon » Thu Feb 15, 2018 4:34 pm

Check it at home, keep a record, give it to your doc on exam day.
"I would rather be certain of a good return than hopeful of a great one" | Warren Buffett

mouses
Posts: 3941
Joined: Sat Oct 24, 2015 12:24 am

Re: How do docs treat "white coat hypertension"?

Post by mouses » Thu Feb 15, 2018 4:38 pm

I'm sure the mods will be along any minute :-)

With your general state of good health and good readings otherwise, how about a chat with your doctor about how concerned you should be about this. I'll bet he or she will say daily measurements are way over doing it.

My bp is normally fine. If I am really stressed in the doctor's office, yes, it will go up temporarily. One thing that helps me is relaxation breathing. I really don't worry much about it, as it is brief.

User avatar
midareff
Posts: 6465
Joined: Mon Nov 29, 2010 10:43 am
Location: Biscayne Bay, South Florida

Re: How do docs treat "white coat hypertension"?

Post by midareff » Thu Feb 15, 2018 4:42 pm

Same issue at every doctor except my primary, whose been my primary >20 years.

Topic Author
davebo
Posts: 840
Joined: Wed Dec 17, 2008 12:02 am

Re: How do docs treat "white coat hypertension"?

Post by davebo » Thu Feb 15, 2018 4:55 pm

midareff wrote:
Thu Feb 15, 2018 4:42 pm
Same issue at every doctor except my primary, whose been my primary >20 years.
Do you just keep records and then show them to him? I don't want them thinking I need to be on meds when I probably don't. I feel like I always get these nurses that give me these very concerned looks. Maybe it would actually settle me down if I told them it upfront.

User avatar
Pajamas
Posts: 6015
Joined: Sun Jun 03, 2012 6:32 pm

Re: How do docs treat "white coat hypertension"?

Post by Pajamas » Thu Feb 15, 2018 5:07 pm

I have the same problem with the dentist or any time I am going to get stuck with a needle. I have learned to walk slowly to get to the appointment, show up early, and listen to music to mindfully relax while waiting.

I have had a dentist tell me that it wasn't possible for me to lower my own blood pressure, but reclining in the chair for five minutes while relaxing while he was getting supplies did the trick. Might have been the reclining rather than the relaxing, not sure which. 8-)
Last edited by Pajamas on Thu Feb 15, 2018 5:09 pm, edited 1 time in total.

User avatar
gasdoc
Posts: 1748
Joined: Mon Nov 03, 2014 8:26 am

Re: How do docs treat "white coat hypertension"?

Post by gasdoc » Thu Feb 15, 2018 5:08 pm

My BP goes up when I am running behind on getting to the appointment on time. If I leave the house 15 minutes earlier, I don't worry about it as I hit every red light in town. Might help?

gasdoc

User avatar
dm200
Posts: 22965
Joined: Mon Feb 26, 2007 2:21 pm
Location: Washington DC area

Re: How do docs treat "white coat hypertension"?

Post by dm200 » Thu Feb 15, 2018 5:10 pm

There is also "hypertension" of males when an attractive female technician, nurse or physician takes his blood pressure. In such cases, having a male take the blood pressure can get a "normal" reading.

Topic Author
davebo
Posts: 840
Joined: Wed Dec 17, 2008 12:02 am

Re: How do docs treat "white coat hypertension"?

Post by davebo » Thu Feb 15, 2018 5:21 pm

dm200 wrote:
Thu Feb 15, 2018 5:10 pm
There is also "hypertension" of males when an attractive female technician, nurse or physician takes his blood pressure. In such cases, having a male take the blood pressure can get a "normal" reading.
She was a female, but I don't think that was the problem in this case..ha.

I think the showing up early would probably help as well as listening to something while I'm there. I feel like if I just break the cycle and get a normal reading in the Docs office, I'll be fine going forward. I just need to calm myself down enough to make it through an appointment.

jayk238
Posts: 620
Joined: Tue Jan 31, 2017 1:02 pm

Re: How do docs treat "white coat hypertension"?

Post by jayk238 » Thu Feb 15, 2018 5:22 pm

I dont think we can ask for medical advice here but this seems more general.

White coat htn is defined as 3 separate in clinic measures elevated w two at home measures that are normal.
Before dx one has to rule out essential and silent htn. If pt has elevated bp at clinic but otherwise ok then best way to rule out silent is to do an ambulatory bp monitoring and see if it spikes during certain times like night time. If its negative then you have wch.

Im just a resident tho.

mouses
Posts: 3941
Joined: Sat Oct 24, 2015 12:24 am

Re: How do docs treat "white coat hypertension"?

Post by mouses » Thu Feb 15, 2018 5:25 pm

Or waiting to take the bp until the doctor has told you the test result is fine. For women, waiting until the obgyn exam is over.

User avatar
ResearchMed
Posts: 9470
Joined: Fri Dec 26, 2008 11:25 pm

Re: How do docs treat "white coat hypertension"?

Post by ResearchMed » Thu Feb 15, 2018 5:26 pm

Do you pay attention to "how" they take your BP?

There was a relatively recent study (cited here on BH unless the thread was removed b/c of 'medical' topics) about how almost no med students (I think that was the group) took BP properly.

There is a list of things to attend to that would take more time/attention... notably waiting a few minutes after the patient has been seated, specific position of arm, not talking at the time... I'm forgetting most of it.

Ever since reading that, it's very difficult not to notice when someone escorts us into the room, perhaps after walking down a long hallway, has us sit down, and immediate starts to take BP, with the arm in the wrong position, not attending to our body position, and keeps asking us questions... etc.

And although we do use an Omron at home (with good readings), we *keep* forgetting to bring it in to compare readings with the equipment in the med offices. :oops:

Also, there is some new equipment in a new med office, where the BP is done a bit differently. Not such strong pressure at the start, and the entire thing is faster. It's "more automated".
And... the BP readings are more similar to what we get at home.

And that's with a new physician, so I'm quite aware of being less "relaxed".

RM
This signature is a placebo. You are in the control group.

staythecourse
Posts: 6993
Joined: Mon Jan 03, 2011 9:40 am

Re: How do docs treat "white coat hypertension"?

Post by staythecourse » Thu Feb 15, 2018 5:36 pm

eye.surgeon wrote:
Thu Feb 15, 2018 4:34 pm
Check it at home, keep a record, give it to your doc on exam day.
Agreed. Anyways, even if it was a little high rest assured the treatment is diet and exercise. We get more upset when folks want a pill just because their number says it is 142/80 instead of 138/80.

Also, keep in mind MANY things increase blood pressure, such as: pain (like when you broke your arm) and anxiety (white coat hypertension as example). Either way keep in mind your blood pressure goes up and down ALL the time. Try checking your blood pressure after chasing down the bus when you are late catching it. I bet it is 180/100. Blood pressure going up and down under different circumstances is how the body is designed to function. Now being up ALL the time, experiencing symptoms from it, and/ or having family history of strokes or heart disease is more concerning.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

Trev H
Posts: 1878
Joined: Fri Mar 02, 2007 10:47 pm

Re: How do docs treat "white coat hypertension"?

Post by Trev H » Thu Feb 15, 2018 5:40 pm

Sounds like you are sort of having a panic attack over something that is not really worthy of getting all that upset about.

There are lots of folks on youtube or other online sources showing you how to deal with panic attacks.

Controlled breathing, tensing and relaxing body parts, etc...

Try it... it works.

Trev H

Hillview
Posts: 382
Joined: Fri Feb 02, 2018 7:27 am

Re: How do docs treat "white coat hypertension"?

Post by Hillview » Thu Feb 15, 2018 5:46 pm

I try to do a little meditation before they take my BP and while they put the cuff on. Controlled breathing and close my eyes and visualize something lovely. It helps me a lot.

User avatar
HomerJ
Posts: 13601
Joined: Fri Jun 06, 2008 12:50 pm

Re: How do docs treat "white coat hypertension"?

Post by HomerJ » Thu Feb 15, 2018 5:49 pm

I always take a bunch of slow deep breaths, relax my muscles, and my blood pressure is always fine.

Part of me wonders if I am sabotaging myself by giving a false GOOD reading to the doctor.
I have had a dentist tell me that it wasn't possible for me to lower my own blood pressure,
I hope this is true, but I doubt it.

Topic Author
davebo
Posts: 840
Joined: Wed Dec 17, 2008 12:02 am

Re: How do docs treat "white coat hypertension"?

Post by davebo » Thu Feb 15, 2018 5:57 pm

staythecourse wrote:
Thu Feb 15, 2018 5:36 pm
eye.surgeon wrote:
Thu Feb 15, 2018 4:34 pm
Check it at home, keep a record, give it to your doc on exam day.
Agreed. Anyways, even if it was a little high rest assured the treatment is diet and exercise. We get more upset when folks want a pill just because their number says it is 142/80 instead of 138/80.

Also, keep in mind MANY things increase blood pressure, such as: pain (like when you broke your arm) and anxiety (white coat hypertension as example). Either way keep in mind your blood pressure goes up and down ALL the time. Try checking your blood pressure after chasing down the bus when you are late catching it. I bet it is 180/100. Blood pressure going up and down under different circumstances is how the body is designed to function. Now being up ALL the time, experiencing symptoms from it, and/ or having family history of strokes or heart disease is more concerning.

Good luck.
Thanks for the info. Honestly, since my BP has been so consistently low I thought I'd have no problem walking into an office and getting a good reading because I was more confident about it. My last episode was at the health screening at work. I left the appointment and went home for lunch (10 minute drive). Elevated at appointment and BP at home was 118/78. I could feel it coming down as soon as I walked out.

Some high blood pressure in my family here and there, but nothing major. I actually don't know anyone on either side of my family that has had a heart attach (parents, aunts, uncles, grandparents, etc).

Trev H
Posts: 1878
Joined: Fri Mar 02, 2007 10:47 pm

Re: How do docs treat "white coat hypertension"?

Post by Trev H » Thu Feb 15, 2018 5:59 pm

What do I do if I’m having a panic attack?

The first step is to acknowledge that you’re having a panic attack and accept the feeling. Then practice these immediate coping techniques:

Relax your breath by practicing 4-7-8 breathing. Inhale through your nose for 4 counts, hold for 7, and exhale through your mouth for 8. Or use a breathing app such as Breathing Zone to help decrease your breathing rate. Don’t try to take deep breaths — this will only make the hyperventilation worse.

Sit or lie down and relax your muscles. Try progressive muscle relaxation. Flex the muscles in your feet and toes, then release. Flex the muscles in your calves, then release. Flex the muscles in your thighs, then release. Continue doing this with each muscle group, moving up your body until you get to your head.

===

Examples above... note these are also good for those nights when you are having trouble falling asleep.

Simply helps you to relax !

In my younger days I was a national staff shooter for high country archery... in very high stress competition situations, practicing controlled breathing helps you to stay calm and focused. Also visualizing a relaxing situation helps too... I remember a day while fishing on a lake when there was no wind and it was so calm... what ever works for you.

If none of that helps === as others have suggested just do the test at home regularly and bring your results with you.

Trev H

Yankuba
Posts: 84
Joined: Wed Dec 07, 2016 10:45 am

Re: How do docs treat "white coat hypertension"?

Post by Yankuba » Thu Feb 15, 2018 6:02 pm

eye.surgeon wrote:
Thu Feb 15, 2018 4:34 pm
Check it at home, keep a record, give it to your doc on exam day.
+1

The machines they use in the walk in clinic and drugstores are always inaccurate for me. I use the Omron at home and at work and get the official reading at my annual checkup with an old school cuff and stethescope. As long as you are low at home you’re good.

User avatar
BeachGlass
Posts: 12
Joined: Sat Jan 12, 2013 4:34 pm

Re: How do docs treat "white coat hypertension"?

Post by BeachGlass » Thu Feb 15, 2018 6:04 pm

I have had the same problem for years. The harder I try to relax, the higher my bp will go! I always tell the nurse upfront that I have white coat hypertension, and I always take along a copy of my recent bp readings to leave with them. I've also taken my Omron bp monitor to the doc's office to verify that it is accurate. It helped when one of my doctors admitted that he also had white coat hypertension.

bondsr4me
Posts: 1304
Joined: Fri Oct 18, 2013 7:08 am

Re: How do docs treat "white coat hypertension"?

Post by bondsr4me » Thu Feb 15, 2018 6:04 pm

My bp is usually higher than normal at my doctor’s office.

I take readings here at home about 3 times a week and record the readings in a Numbers spreadsheet.
I print the form and give it to my doctor when I go for my appointment.
I also take my bp machine to my appointment. My doctor lets me do a reading as I do at home.
He then takes his own reading to verify the validity of my readings.
He has always been satisfied with my results.

As I said, the readings at his office are almost always higher than my home readings.

Don

jayk238
Posts: 620
Joined: Tue Jan 31, 2017 1:02 pm

Re: How do docs treat "white coat hypertension"?

Post by jayk238 » Thu Feb 15, 2018 6:09 pm

ResearchMed wrote:
Thu Feb 15, 2018 5:26 pm
Do you pay attention to "how" they take your BP?

There was a relatively recent study (cited here on BH unless the thread was removed b/c of 'medical' topics) about how almost no med students (I think that was the group) took BP properly.

There is a list of things to attend to that would take more time/attention... notably waiting a few minutes after the patient has been seated, specific position of arm, not talking at the time... I'm forgetting most of it.

Ever since reading that, it's very difficult not to notice when someone escorts us into the room, perhaps after walking down a long hallway, has us sit down, and immediate starts to take BP, with the arm in the wrong position, not attending to our body position, and keeps asking us questions... etc.

And although we do use an Omron at home (with good readings), we *keep* forgetting to bring it in to compare readings with the equipment in the med offices. :oops:

Also, there is some new equipment in a new med office, where the BP is done a bit differently. Not such strong pressure at the start, and the entire thing is faster. It's "more automated".
And... the BP readings are more similar to what we get at home.

And that's with a new physician, so I'm quite aware of being less "relaxed".

RM
Proper way to take bp is to wait 5 min seated. Then hve the cuff so that the artery line lines up w the cuff line. Then have the patient arm relaxed and raise it so it is at heart level. Then take the stethescope and place where the artery is. Next inflate cuff until and past usual bp- i usually go past 220 because of what is known as auscultory gap. Then deflate the cuff. This is the accepted way.

PFInterest
Posts: 2684
Joined: Sun Jan 08, 2017 12:25 pm

Re: How do docs treat "white coat hypertension"?

Post by PFInterest » Thu Feb 15, 2018 6:18 pm

jayk238 wrote:
Thu Feb 15, 2018 6:09 pm
ResearchMed wrote:
Thu Feb 15, 2018 5:26 pm
Do you pay attention to "how" they take your BP?

There was a relatively recent study (cited here on BH unless the thread was removed b/c of 'medical' topics) about how almost no med students (I think that was the group) took BP properly.

There is a list of things to attend to that would take more time/attention... notably waiting a few minutes after the patient has been seated, specific position of arm, not talking at the time... I'm forgetting most of it.

Ever since reading that, it's very difficult not to notice when someone escorts us into the room, perhaps after walking down a long hallway, has us sit down, and immediate starts to take BP, with the arm in the wrong position, not attending to our body position, and keeps asking us questions... etc.

And although we do use an Omron at home (with good readings), we *keep* forgetting to bring it in to compare readings with the equipment in the med offices. :oops:

Also, there is some new equipment in a new med office, where the BP is done a bit differently. Not such strong pressure at the start, and the entire thing is faster. It's "more automated".
And... the BP readings are more similar to what we get at home.

And that's with a new physician, so I'm quite aware of being less "relaxed".

RM
Proper way to take bp is to wait 5 min seated. Then hve the cuff so that the artery line lines up w the cuff line. Then have the patient arm relaxed and raise it so it is at heart level. Then take the stethescope and place where the artery is. Next inflate cuff until and past usual bp- i usually go past 220 because of what is known as auscultory gap. Then deflate the cuff. This is the accepted way.
ha, wait 5 mins! for 35 patients a day. HA!

User avatar
ResearchMed
Posts: 9470
Joined: Fri Dec 26, 2008 11:25 pm

Re: How do docs treat "white coat hypertension"?

Post by ResearchMed » Thu Feb 15, 2018 6:21 pm

PFInterest wrote:
Thu Feb 15, 2018 6:18 pm
jayk238 wrote:
Thu Feb 15, 2018 6:09 pm
ResearchMed wrote:
Thu Feb 15, 2018 5:26 pm
Do you pay attention to "how" they take your BP?

There was a relatively recent study (cited here on BH unless the thread was removed b/c of 'medical' topics) about how almost no med students (I think that was the group) took BP properly.

There is a list of things to attend to that would take more time/attention... notably waiting a few minutes after the patient has been seated, specific position of arm, not talking at the time... I'm forgetting most of it.

Ever since reading that, it's very difficult not to notice when someone escorts us into the room, perhaps after walking down a long hallway, has us sit down, and immediate starts to take BP, with the arm in the wrong position, not attending to our body position, and keeps asking us questions... etc.

And although we do use an Omron at home (with good readings), we *keep* forgetting to bring it in to compare readings with the equipment in the med offices. :oops:

Also, there is some new equipment in a new med office, where the BP is done a bit differently. Not such strong pressure at the start, and the entire thing is faster. It's "more automated".
And... the BP readings are more similar to what we get at home.

And that's with a new physician, so I'm quite aware of being less "relaxed".

RM
Proper way to take bp is to wait 5 min seated. Then hve the cuff so that the artery line lines up w the cuff line. Then have the patient arm relaxed and raise it so it is at heart level. Then take the stethescope and place where the artery is. Next inflate cuff until and past usual bp- i usually go past 220 because of what is known as auscultory gap. Then deflate the cuff. This is the accepted way.
ha, wait 5 mins! for 35 patients a day. HA!
It's often done by someone other than the physician, while waiting for the physician, at least unless there is some special concern that the physician wants to double check, etc.

RM
This signature is a placebo. You are in the control group.

Enzo IX
Posts: 200
Joined: Wed Jul 23, 2008 4:07 am

Re: How do docs treat "white coat hypertension"?

Post by Enzo IX » Thu Feb 15, 2018 6:30 pm

You are not alone.

I check my BP usually daily with a OMRON machine and as others have said it varies somewhat according to time of day, but is usually at or under the generally accepted 120/80.

Go for my annual checkup and the BP is usually 10 to 15 points higher at the Dr's office. I am constantly worried about coming in and getting bad news on my bloodwork especially about blood glucose (diabetes everyone in the family has it).

One thing I have noticed recently that I correlate to lowering my BP is I switched from black coffed to green tea. Also I have been drinking one large cup of various fruits and vegetables using the Nutri blender in the morning. When I juiced one red beet with the leafy top included, my BP dropped 15 points to like 105/65 when I checked it. Still testing to see if was an anomally or if it is correlated.

Topic Author
davebo
Posts: 840
Joined: Wed Dec 17, 2008 12:02 am

Re: How do docs treat "white coat hypertension"?

Post by davebo » Thu Feb 15, 2018 6:57 pm

Enzo IX wrote:
Thu Feb 15, 2018 6:30 pm
You are not alone.

I check my BP usually daily with a OMRON machine and as others have said it varies somewhat according to time of day, but is usually at or under the generally accepted 120/80.

Go for my annual checkup and the BP is usually 10 to 15 points higher at the Dr's office. I am constantly worried about coming in and getting bad news on my bloodwork especially about blood glucose (diabetes everyone in the family has it).

One thing I have noticed recently that I correlate to lowering my BP is I switched from black coffed to green tea. Also I have been drinking one large cup of various fruits and vegetables using the Nutri blender in the morning. When I juiced one red beet with the leafy top included, my BP dropped 15 points to like 105/65 when I checked it. Still testing to see if was an anomally or if it is correlated.
Yes, sounds like me. I don't even have any diabetes in my family and I get anxious about stuff like that. I actually monitor my blood glucose levels at home and I'm not sure if that is a good or bad thing. Good because I'm managing things instead of letting them get bad, bad because I probably overthink it a bit.

I likely had borderline high BP (not high enough to medicate) last year, but cleaned up my diet a lot. Now my numbers come in much lower on a regular basis. What I thought would happen is that I'd have a spike in blood pressure, but it wouldn't be that big of a deal because my baseline was much lower than it had been. Nope, my spike went up to the same level it was before.

jayk238
Posts: 620
Joined: Tue Jan 31, 2017 1:02 pm

Re: How do docs treat "white coat hypertension"?

Post by jayk238 » Thu Feb 15, 2018 7:01 pm

PFInterest wrote:
Thu Feb 15, 2018 6:18 pm
jayk238 wrote:
Thu Feb 15, 2018 6:09 pm
ResearchMed wrote:
Thu Feb 15, 2018 5:26 pm
Do you pay attention to "how" they take your BP?

There was a relatively recent study (cited here on BH unless the thread was removed b/c of 'medical' topics) about how almost no med students (I think that was the group) took BP properly.

There is a list of things to attend to that would take more time/attention... notably waiting a few minutes after the patient has been seated, specific position of arm, not talking at the time... I'm forgetting most of it.

Ever since reading that, it's very difficult not to notice when someone escorts us into the room, perhaps after walking down a long hallway, has us sit down, and immediate starts to take BP, with the arm in the wrong position, not attending to our body position, and keeps asking us questions... etc.

And although we do use an Omron at home (with good readings), we *keep* forgetting to bring it in to compare readings with the equipment in the med offices. :oops:

Also, there is some new equipment in a new med office, where the BP is done a bit differently. Not such strong pressure at the start, and the entire thing is faster. It's "more automated".
And... the BP readings are more similar to what we get at home.

And that's with a new physician, so I'm quite aware of being less "relaxed".

RM
Proper way to take bp is to wait 5 min seated. Then hve the cuff so that the artery line lines up w the cuff line. Then have the patient arm relaxed and raise it so it is at heart level. Then take the stethescope and place where the artery is. Next inflate cuff until and past usual bp- i usually go past 220 because of what is known as auscultory gap. Then deflate the cuff. This is the accepted way.
ha, wait 5 mins! for 35 patients a day. HA!
I only do this for thsoe whose bp I am managing, usually the MA does the electronic BP for my attendings anyway so I only do it for patients woh need a BP, whose BP is abnormal on eelctronic, and who have BP management issues I do it during hte encounter anyway as its part of teh alloted time

jayk238
Posts: 620
Joined: Tue Jan 31, 2017 1:02 pm

Re: How do docs treat "white coat hypertension"?

Post by jayk238 » Thu Feb 15, 2018 7:03 pm

ResearchMed wrote:
Thu Feb 15, 2018 6:21 pm
PFInterest wrote:
Thu Feb 15, 2018 6:18 pm
jayk238 wrote:
Thu Feb 15, 2018 6:09 pm
ResearchMed wrote:
Thu Feb 15, 2018 5:26 pm
Do you pay attention to "how" they take your BP?

There was a relatively recent study (cited here on BH unless the thread was removed b/c of 'medical' topics) about how almost no med students (I think that was the group) took BP properly.

There is a list of things to attend to that would take more time/attention... notably waiting a few minutes after the patient has been seated, specific position of arm, not talking at the time... I'm forgetting most of it.

Ever since reading that, it's very difficult not to notice when someone escorts us into the room, perhaps after walking down a long hallway, has us sit down, and immediate starts to take BP, with the arm in the wrong position, not attending to our body position, and keeps asking us questions... etc.

And although we do use an Omron at home (with good readings), we *keep* forgetting to bring it in to compare readings with the equipment in the med offices. :oops:

Also, there is some new equipment in a new med office, where the BP is done a bit differently. Not such strong pressure at the start, and the entire thing is faster. It's "more automated".
And... the BP readings are more similar to what we get at home.

And that's with a new physician, so I'm quite aware of being less "relaxed".

RM
Proper way to take bp is to wait 5 min seated. Then hve the cuff so that the artery line lines up w the cuff line. Then have the patient arm relaxed and raise it so it is at heart level. Then take the stethescope and place where the artery is. Next inflate cuff until and past usual bp- i usually go past 220 because of what is known as auscultory gap. Then deflate the cuff. This is the accepted way.
ha, wait 5 mins! for 35 patients a day. HA!
It's often done by someone other than the physician, while waiting for the physician, at least unless there is some special concern that the physician wants to double check, etc.

RM
no non-physicians I know of do this. Its all electronically done. I may be the only one who does it correctly in my residency because I am anal about the physical exam.

User avatar
Earl Lemongrab
Posts: 7270
Joined: Tue Jun 10, 2014 1:14 am

Re: How do docs treat "white coat hypertension"?

Post by Earl Lemongrab » Thu Feb 15, 2018 7:17 pm

When I got my home unit, the doctor had me bring it for a comparison. She took it, then we did one with the device. They were close.

User avatar
ResearchMed
Posts: 9470
Joined: Fri Dec 26, 2008 11:25 pm

Re: How do docs treat "white coat hypertension"?

Post by ResearchMed » Thu Feb 15, 2018 7:19 pm

jayk238 wrote:
Thu Feb 15, 2018 7:03 pm
ResearchMed wrote:
Thu Feb 15, 2018 6:21 pm
PFInterest wrote:
Thu Feb 15, 2018 6:18 pm
jayk238 wrote:
Thu Feb 15, 2018 6:09 pm
ResearchMed wrote:
Thu Feb 15, 2018 5:26 pm
Do you pay attention to "how" they take your BP?

There was a relatively recent study (cited here on BH unless the thread was removed b/c of 'medical' topics) about how almost no med students (I think that was the group) took BP properly.

There is a list of things to attend to that would take more time/attention... notably waiting a few minutes after the patient has been seated, specific position of arm, not talking at the time... I'm forgetting most of it.

Ever since reading that, it's very difficult not to notice when someone escorts us into the room, perhaps after walking down a long hallway, has us sit down, and immediate starts to take BP, with the arm in the wrong position, not attending to our body position, and keeps asking us questions... etc.

And although we do use an Omron at home (with good readings), we *keep* forgetting to bring it in to compare readings with the equipment in the med offices. :oops:

Also, there is some new equipment in a new med office, where the BP is done a bit differently. Not such strong pressure at the start, and the entire thing is faster. It's "more automated".
And... the BP readings are more similar to what we get at home.

And that's with a new physician, so I'm quite aware of being less "relaxed".

RM
Proper way to take bp is to wait 5 min seated. Then hve the cuff so that the artery line lines up w the cuff line. Then have the patient arm relaxed and raise it so it is at heart level. Then take the stethescope and place where the artery is. Next inflate cuff until and past usual bp- i usually go past 220 because of what is known as auscultory gap. Then deflate the cuff. This is the accepted way.
ha, wait 5 mins! for 35 patients a day. HA!
It's often done by someone other than the physician, while waiting for the physician, at least unless there is some special concern that the physician wants to double check, etc.

RM
no non-physicians I know of do this. Its all electronically done. I may be the only one who does it correctly in my residency because I am anal about the physical exam.
At our major teaching hospital, at NO clinic (primary care or any specialties) does the physician regularly take BP measures. It's someone else, but these days, it's sometimes difficult to tell quickly if it's a nurse, a nurse practitioner, physician assistant, or...?

IF there is an issue that does/might concern BP (or just general concerns, perhaps), then the physician will *also* take BP.
But yes, IF someone takes it a second time, them it tends to be the non-electronic way.

And as for "non-physicians", although we both have "physicians" as our PCP (Primary Care Practitioner), it seems to be increasing that a PCP might be a nurse practitioner or someone else other than an "M.D." who is the caretaker.
So in these cases, there may not be any physician who ever sees the patient, unless there is a referral.

RM
This signature is a placebo. You are in the control group.

jayk238
Posts: 620
Joined: Tue Jan 31, 2017 1:02 pm

Re: How do docs treat "white coat hypertension"?

Post by jayk238 » Thu Feb 15, 2018 7:21 pm

ResearchMed wrote:
Thu Feb 15, 2018 7:19 pm
jayk238 wrote:
Thu Feb 15, 2018 7:03 pm
ResearchMed wrote:
Thu Feb 15, 2018 6:21 pm
PFInterest wrote:
Thu Feb 15, 2018 6:18 pm
jayk238 wrote:
Thu Feb 15, 2018 6:09 pm


Proper way to take bp is to wait 5 min seated. Then hve the cuff so that the artery line lines up w the cuff line. Then have the patient arm relaxed and raise it so it is at heart level. Then take the stethescope and place where the artery is. Next inflate cuff until and past usual bp- i usually go past 220 because of what is known as auscultory gap. Then deflate the cuff. This is the accepted way.
ha, wait 5 mins! for 35 patients a day. HA!
It's often done by someone other than the physician, while waiting for the physician, at least unless there is some special concern that the physician wants to double check, etc.

RM
no non-physicians I know of do this. Its all electronically done. I may be the only one who does it correctly in my residency because I am anal about the physical exam.
At our major teaching hospital, at NO clinic (primary care or any specialties) does the physician regularly take BP measures. It's someone else, but these days, it's sometimes difficult to tell quickly if it's a nurse, a nurse practitioner, physician assistant, or...?

IF there is an issue that does/might concern BP (or just general concerns, perhaps), then the physician will *also* take BP.
But yes, IF someone takes it a second time, them it tends to be the non-electronic way.

And as for "non-physicians", although we both have "physicians" as our PCP (Primary Care Practitioner), it seems to be increasing that a PCP might be a nurse practitioner or someone else other than an "M.D." who is the caretaker.
So in these cases, there may not be any physician who ever sees the patient, unless there is a referral.

RM
Thats too bad. I hope that as the sole PCP for my patients in my panel I can provide high quality care instead of referring everyone out. Then again most of my patients will be complex patients with a lot of stuff going on.

DrGoogle2017
Posts: 2528
Joined: Mon Aug 14, 2017 12:31 pm

Re: How do docs treat "white coat hypertension"?

Post by DrGoogle2017 » Thu Feb 15, 2018 7:26 pm

My brother has high bp, he eats lots of celery per day. That’s what I do, I eat lots of celery when I’m not travelling. Plus I’m not really a coffee drinker. I do what I can to reduce my bp, not sure if I even have a problem.
The doctor’s office usually take my bp twice to get correct reading. I wouldn’t worry about. I often joke that I raise people’s bp. The less you worry the better.

mouses
Posts: 3941
Joined: Sat Oct 24, 2015 12:24 am

Re: How do docs treat "white coat hypertension"?

Post by mouses » Thu Feb 15, 2018 7:32 pm

ResearchMed wrote:
Thu Feb 15, 2018 7:19 pm
At our major teaching hospital, at NO clinic (primary care or any specialties) does the physician regularly take BP measures. It's someone else, but these days, it's sometimes difficult to tell quickly if it's a nurse, a nurse practitioner, physician assistant, or...?
...
And as for "non-physicians", although we both have "physicians" as our PCP (Primary Care Practitioner), it seems to be increasing that a PCP might be a nurse practitioner or someone else other than an "M.D." who is the caretaker.
So in these cases, there may not be any physician who ever sees the patient, unless there is a referral.

RM
One of my peeves, and I think unethical, is when a physicians assistant introduces themselves as Dr. If you don't know this person, you assume you are being treated by someone with the skills of a doctor.

User avatar
ResearchMed
Posts: 9470
Joined: Fri Dec 26, 2008 11:25 pm

Re: How do docs treat "white coat hypertension"?

Post by ResearchMed » Thu Feb 15, 2018 7:37 pm

mouses wrote:
Thu Feb 15, 2018 7:32 pm
ResearchMed wrote:
Thu Feb 15, 2018 7:19 pm
At our major teaching hospital, at NO clinic (primary care or any specialties) does the physician regularly take BP measures. It's someone else, but these days, it's sometimes difficult to tell quickly if it's a nurse, a nurse practitioner, physician assistant, or...?
...
And as for "non-physicians", although we both have "physicians" as our PCP (Primary Care Practitioner), it seems to be increasing that a PCP might be a nurse practitioner or someone else other than an "M.D." who is the caretaker.
So in these cases, there may not be any physician who ever sees the patient, unless there is a referral.

RM
One of my peeves, and I think unethical, is when a physicians assistant introduces themselves as Dr. If you don't know this person, you assume you are being treated by someone with the skills of a doctor.
That really shouldn't be done!
I agree that that is unethical, or worse.

At least, in our facilities, the Practitioner, when first walking in the door - if they don't already know you - will announce their name AND specify the title. I guess that would be except for actual physician/M.D.'s, who will just say "Dr. X".

But I'm not sure everyone knows the difference (especially about the various flavors of non-physician practitioners), or perhaps just don't notice due to stress or just assume "it's The Doctor"...

RM
This signature is a placebo. You are in the control group.

Dottie57
Posts: 7566
Joined: Thu May 19, 2016 5:43 pm
Location: Earth Northern Hemisphere

Re: How do docs treat "white coat hypertension"?

Post by Dottie57 » Thu Feb 15, 2018 7:42 pm

eye.surgeon wrote:
Thu Feb 15, 2018 4:34 pm
Check it at home, keep a record, give it to your doc on exam day.

Also bring along your monitor to see how well it reads your pressure.

User avatar
LadyGeek
Site Admin
Posts: 58842
Joined: Sat Dec 20, 2008 5:34 pm
Location: Philadelphia
Contact:

Re: How do docs treat "white coat hypertension"?

Post by LadyGeek » Thu Feb 15, 2018 7:42 pm

This thread has run its course and is locked (medical advice). See: Medical Issues
Questions on medical issues are beyond the scope of the forum. If you are looking for medical information online, I suggest you start with the Medical Library Association's User's Guide to Finding and Evaluating Health Information on the Web which, in addition to providing guidance on evaluating health information, includes a list of their top recommended sites.
Wiki To some, the glass is half full. To others, the glass is half empty. To an engineer, it's twice the size it needs to be.

Locked