How to treate white coat syndrome?
DEAR DR. ROACH: I have had high blood pressure at times, and my doctor said I have white coat syndrome. I am on metoprolol and ramipril. My blood pressure spikes at times. Recently I didn’t feel right. My blood pressure was reading 200/120, more or less, over 12 hours. I went to my doctor, who gave me something that would bring it down and told me to double up on metoprolol. I took readings at home, and for the next three days it was better but still on the high side. The average over 12 hours was 145/90.
I went to a specialist and took along my readings. He didn’t seem alarmed that I had several spikes of 190/105. He told me it’s normal to have high blood pressure readings, everyone has them. I can understand occasional spikes, but mine goes up and stays up for hours. —G.
ANSWER: Let’s first define whitecoat hypertension, also called reactive hypertension. It’s a condition where blood pressure in the doctor’s office is much higher than blood pressure at home. Consistent regular readings at home are a better marker of overall blood pressure. At first glance, that doesn’t seem to be what you have. You have high blood pressure consistently, at least recently.
Even people whose blood pressure generally is well-controlled — either naturally or because they take medication — will have some readings that are higher than others. However, readings of 195/105 are too high. Even your relatively better average of 145/90 is too high.
One test that is often done is called an ambulatory blood pressure measurement. A blood pressure monitor is worn for 24 hours and takes your blood pressure every 15-20 minutes during the day and 30-60 minutes during sleep. It’s possible that your blood pressure is normally in the good range but spikes every time you or your doctor take it — I have seen a few cases of this.
An echocardiogram also can detect changes in the heart, most commonly enlargement of the left ventricle, which may show damage from high blood pressure. I suspect you may need additional treatment. This is usually medication, but salt restriction and stress management can reduce blood pressure in most people.
High blood pressure is one of our most common ailments. The booklet on it describes what it does and how it’s treated. Readers can order a copy by writing: Dr. Roach — No. 104W, Box 536475, Orlando, FL 32853- 6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. ROACH: Some time ago, I had a lot of noise coming from my stomach, a kind of growling sound. It went away, but now it comes on again once in a while. No pain, just the noise. — T.
ANSWER: These noises go by the official-sounding name of borborygmi (BOR-boh-RIG-mee), and are both common and normal the vast majority of the time. They reflect the movement of the stomach and the intestines. Since there is no pain, you don’t have to do anything about them.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]. To view and order health pamphlets, visit rbmamall.com, or write to P.O. Box 536475, Orlando, FL 32853-6475. © 2014 North America Synd., Inc. All Rights Reserved