Why 'White Coat Syndrome' and The Pandemic Are A Double Threat

These past two years have been fraught with enough challenges to make anyone’s blood pressure spike. From wildfires around the world to the novel coronavirus pandemic, these several months have provided plenty of coverage to raise alarm. But for those with white coat syndrome, these circumstances have created additional cause for concern.

White coat syndrome, or ‘white coat hypertension’, is a phenomenon whereby patients experience elevated blood pressure when they are in the presence of a medical professional or when their blood pressure is being measured at a medical office.

When not in the presence of a medical professional or ‘white coat’, these same patients exhibit normative blood pressure levels. The presence of the ‘white coat’ triggers the physiological response of a subsequent rise in blood pressure. Essentially, it is a conditioned response by the body to react in response to the stimulus of the white coat. It is not unlike the renowned Pavlov’s Dog findings — except, instead of salivating when you hear a bell, your blood pressure rises when you’re in a medical setting.

If we consider that one of the criteria for white coat hypertension dictates that a patient’s blood pressure is otherwise normal outside of the medical environment, some may assume it is a minor problem. But research suggests this is not the case.

Patients with white coat hypertension are at a greater risk for heart disease when compared to others with normative blood pressure. For those that are aware of their white coat hypertension, and/or experience anxiety in response to a medical setting, it is not unusual for patients to avoid the medical environment altogether.

Conscious awareness isn’t always needed, of course. It is often the human tendency to simply avoid what we don’t like. This can spell trouble in a myriad of different ways, from a decrease in regular checkups to missed medical tests. If we just look at skin checks or regular appointments with a dermatologists, the data suggests that thousands are going without regular skin checks, and potentially missing out on important diagnoses.

Of course, the problem is understandable. Many patients fear trips to the doctor during the pandemic, even if the trip is warranted. A trip to the local physician could spell potential exposure to the novel coronavirus. Missed trips to the doctor are seen across a variety of areas, and cancer screenings are seeing a huge hit. Adding white coat hypertension into the equation further complicates matters.

Double trouble — viral exposure concerns & hypertension

The challenges of white coat syndrome coupled with those of the novel coronavirus create a double threat. At the beginning of the pandemic, the National Syndromic Surveillance Program (NSSP) discovered a 42% decline in Emergency Department visits. A similar decline was seen in ER visits for heart attack, stroke, and uncontrolled high blood pressure. Some medical professionals have reported patients declining organ transplants due to fears of exposure to COVID-19 or because they cannot have a family member with them in the hospital. For persons with white coat hypertension, these effects may be amplified.

Unfortunately, heart attacks don’t stop just because we are in the middle of a global pandemic.

It is still important to get regular checkups and undergo any procedures which are essential to maintaining health. As we continue to navigate these uncertain waters, it is important that we do not allow fear to prevent us from taking care of our health.

Staying healthy during a pandemic means being your own advocate. Listen to your doctor and do your own research. Explore options for telemedicine, which can make healthcare more accessible whilst mitigating risks of in-person visits. One of the most important things you can do is to be mindful of your own health. In these uncertain times, being your own advocate is one of the few things you can control.

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This article was previously published on Being Well.

About James Goydos, M.D.

James Goydos is a doctor, surgeon & expert on skin cancer. With an M.D. from Rutgers, he has experience as a Professor of Surgery, Surgical Oncologist, & clinical trial leader. He writes on cancer & serves on the editorial board for AACR.

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