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People with white coat syndrome have a higher rate of cardiac events than people who don't (assuming their "actual" BP is equal). One possible explanation is that they may spend more of their day at a higher level of BP due to their stress response and its effect on BP.
I'd also question how much of one's day is spent perfectly still and silent. If 120/80 is the lowest reading you can ever get, and that happens under pefect conditions and a substantial break from all moving and activity, you're probably spending a significant portion of your day at higher levels.
Of course the reading when taken correctly is going to be lower than what it is much of the day. This is obvious and normal. There has to be a standard situation and that is relaxed. There is no standard degree of activity and adrenaline etc. so the standard has to be chilled out. What is my blood pressure with my trainer? How about going up a steep hill on my bicycle? How about when I am racing a stock car on a 1/4 mile dirt track? No medical authority is going to tell you to be inactive because your pulse rate and BP increase in response to activity except possibly to some degree if you have a serious heart condition.
This has always worked for me, but maybe I'm special.
Cardiologist stays overbooked so he wants to offload ekg and BP to nursing staff. We go back 10 years and he knows I consider it really stupid not to be honest with a doctor or withhold information.
IMHO there's a big difference between pitching a fit/refusing if a nurse tries to take a BP reading at the wrong moment during an appointment and handling it by commenting how biased that reading may end up being and suggesting that they'll want to take it later or repeat it. Guess how bent out of shape you allow yourself to get over the situation is up to you. Which, BTW, influences a BP reading!
Though my BP isn't an issue in general and I don't take mine very often, I know from experience the reading will most likely be higher at an appointment. Either I was rushing around to get there on time, I'm a little anxious about the reason for the visit or some test or procedure I'm about to have, I just climbed a flight of steps, or I haven't had enough time to sit down or "assume the position". So, a nurse takes a reading. Big whoop! It reflects a moment in time, not a trend. Trend matters. I know BP changes from moment to moment, the nurse knows it and the doctor I'm seeing knows it. All I have to do is comment that it's higher than my normal resting state and that it bears repeating and charting. Haven't had a nurse get aggressive with me over that approach yet!
Seems silly to take it knowing full well in advance the result will be higher than if proper protocol is followed.
My husband has a terrible time with dr office's who only have a one size cuff blood pressure machines. His arms are muscular and are bigger than normal arms. The assistants always take his bp with the too tight cuffs and it comes out really high. He asked one office if they had a bigger cuff size and they said no and acted like they did not know that having different size cuffs was even possible. He had to take in his readings from home and his machine to show they were wrong.He also told them they need to get educated about such things,(he was sorta ticked off), never went back to that office after the 2nd visit.
I was wondering if he was unique in this problem. Found this article talking about the cuff sizes need to be the right size for the arms.... https://www.ama-assn.org/delivering-...es-not-fit-all
Pointless to take my blood pressure when the result will be wildly inaccurate. I have no sooner sat on the exam table and you want to take it. The only way to have a meaningful blood pressure result is to have a consistent standard for the status of the patient and that would be totally relaxed. Being recently active could be any level from mildly elevated to still frustrated by rush hour traffic and you barely made it to the appointment on time and just walked briskly down a long hallway.
Nurse was real pissed off and at first said she had to take it -- it was required. I refused. When the cardiologist came in I told him my BP reading from the day before relaxed at home. He was fine with that.
The nurse came back at the end of the visit for a different reason after the doctor had left and I cheerfully told her "Oh by the way, my blood pressure is fine." "Oh what was it?" "117/69 when I took it at home yesterday as I reported to Dr. Nyugen." No comment.
It rubs me the wrong way to have a bunch of bogus information in my medical records even if nobody but me cares.
Sad that the test is almost universally done incorrectly despite the proper protocol -- 5 minute minimum to relax, not even talking, both feet on the floor, arm at or above heart level -- is hardly a secret but convenience wins over accuracy.
One time a dentist's nurse took my blood pressure not following protocol and with a cheesy wrist device: 172/120. I would be on the way to E.R except I knew better than to believe it.
Did you run in the door and straight to the examining table? If you were sitting in the waiting room isn't that relaxed enough?
My BP is usually around 110/70 at the Dr's office, the first time when I get called to the back for my appointment. But sometimes I ride my bike to the Dr's office and it takes longer for my BP to return to normal. And then, my BP might be 125/85. When it registers that high, I ask for a re-do when the Dr. comes in for the exam. By that time it's usually back down to my "true" relaxed BP of 100/65. It used to be 90/60, for my teenage years all the way up into my 30's.
I guess I don't care, since I am not going to take any action based on my Doctor's perception of my blood pressure anyway. Now, if I go in and there is a sudden spike in blood pressure from the last visit, then I am listening. In other words, for me it is the delta not the absolute number.
But yes, they always take blood pressure too soon and today use the automated method that is never as accurate as the old hand pump method. The automated device always reads high.
But it is just a few points and I am not going to make the Nurse's day more aggravating by being an uncooperative patient for something that is ball park at best. We all know BP varies throughout the course of the day, with activity. Even after eating will change your resting blood pressure, so I don't sweat it.
To me, it is not a big deal and not worth fighting over.
My BP is usually around 110/70 at the Dr's office, the first time when I get called to the back for my appointment. But sometimes I ride my bike to the Dr's office and it takes longer for my BP to return to normal. And then, my BP might be 125/85. When it registers that high, I ask for a re-do when the Dr. comes in for the exam. By that time it's usually back down to my "true" relaxed BP of 100/65. It used to be 90/60, for my teenage years all the way up into my 30's.
Mine was around that low most of my life, until I found a thyroid supplement that worked (for hypothyroid). Some healthcare providers would be alarmed at the low numbers, and would tell me I needed to bring it up.
But I read an article maybe 10-15 years ago, that said the new guidelines consider 95/70 (give/take) to be the goal, and the reasoning for that is, that throughout the day, your bp goes up and down depending on your activity level. So for it to average out to a "healthy" level, you need it to be that low when calm and being tested. This is what I'd tried to explain to doctors or nurses most of my life; when you take the patient's BP, you're only capturing one moment out of a whole day. What about the rest of the day? You have no idea what's going on the rest of the time when they're not in your office. "Too low" is good, especially for people who lead active lives doing sports and other recreational activities, or taking care of small children; carrying them around, or whatever, loading strollers into the car, etc.
Now I always ask the nurse/PA to take my BP at the end of the taking-vital-signs procedure, to give my BP time to settle down after rushing to the appointment.
Thanks for posting this thread. I feel exactly the same way. I only had one doctor out of several in Alabama that followed apparently fairly recent new protocol: waiting 10 mins. to take a patient's blood pressure. That was at UAB Medical Center in Birmingham - a wonderful place, very professional -- and friendly and courteous, I might add.
I had one office that used antiquated equipment that consistently gave a reading forty points higher than every other office. They finally got a digital device, and guess what: it still registered at least 40 points above my normal, and every other office's reading. That is just lame. I started refusing to have my pressure taken there and insisted on them putting the usual reading in my chart. That was not met with, shall we say, enthusiasm.
And yes, I've had workers get huffy with me when I ask them to wait to take blood pressure.
Actually it's that "antiquated equipment", ie, a manual sphygmomanometer ( blood pressure cuff inflated manually with a gauge attached) and a stethoscope used by the operator to listen for pulse sounds as the cuff is inflated and deflated, that
is the reference method, if you will, for blood pressure readings. In the hands of a skilled operator, it's considered less subject to sources of error that lead to erroneous readings with digital blood pressure monitors. In one of the medical establishments I attend their policy is to take the blood pressure with a digital monitor, and check with a manual reading if the
digital reading is too high ( or low, I guess, mine tends to be high). Whether this makes much sense or not, I don't know, but that is what they do.
My PCP and cardiologist's office do manual blood pressure readings, they believe these are more accurate than digital readings. They're usually taken when you're called into an exam room, but that is after waiting for some time in the waiting room, so I figure that's enough time to relax a bit from the vicissitudes of getting to the office. If I'm uptight about the visit or,anything else my blood pressure will be high no matter what I do.
My husband has a terrible time with dr office's who only have a one size cuff blood pressure machines. His arms are muscular and are bigger than normal arms. The assistants always take his bp with the too tight cuffs and it comes out really high. He asked one office if they had a bigger cuff size and they said no and acted like they did not know that having different size cuffs was even possible. He had to take in his readings from home and his machine to show they were wrong.He also told them they need to get educated about such things,(he was sorta ticked off), never went back to that office after the 2nd visit.
I was wondering if he was unique in this problem. Found this article talking about the cuff sizes need to be the right size for the arms.... https://www.ama-assn.org/delivering-...es-not-fit-all
No, he's not unusual at all, and most doc's offices have several sizes of blood pressure cuffs to fit the arms of all size patients. It's a well known fact that a too small/tight blood pressure cuff will result in erroneously high readings. They know better than to assume it's a "one size fits all" thing.
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