Dr. Wy, why do I always have a higher blood pressure in my doctor’s office compared to the ones I measure at home? Does it mean I need more treatment?

Ask Dr. Wy…

Richard Wyderski, MD, FACP

Dr. Wy, why do I always have a higher blood pressure in my doctor’s office compared to the ones I measure at home? Does it mean I need more treatment?

My March article talked about the importance of achieving an average blood pressure of less than 130/80, but it is true that about 20% of adults have elevated blood pressure at the doctor’s office while having normal blood pressure at home. This is called “white coat” hypertension and treating it has been a source of controversy.

The best evidence of its importance comes from a study published in 2019 conducted by researchers at the University of Pennsylvania.

They analyzed 27 studies, comprising more than 60,000 patients, and found that patients with untreated white coat hypertension had an increased risk of 36% for heart disease, 33% for death from all causes, and 109% for death from heart disease. They also found that patients with white coat hypertension who were taking medication to treat their high blood pressure did not have an increased risk of heart disease or death compared to those with normal blood pressure readings.

So does that mean we should treat high blood pressure only as it’s measured in the office? Well, it depends, and next month we’ll go into how blood pressure should be measured and whether just using the blood pressure in a doctor’s office is enough.

We must be careful to neither undertreat nor overtreat blood pressure since medications can obviously have unwanted side effects, too. Both are important!

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