White Coat Syndrome – Understanding the Link with Hypertension


It’s a scene many in Singapore can relate to: you’re sitting in a clinic, and as the doctor wraps the blood pressure cuff around your arm, you feel your heart rate quicken. The reading comes out higher than usual. Yet, when you check your blood pressure outside the clinic, it’s perfectly normal. This phenomenon, where patients record a blood pressure level higher in a clinical setting than they do in other environments, is known as ‘White Coat Syndrome’ (WCS). But how is this syndrome related to hypertension, and why is it essential for us to be aware of it ?

Unveiling White Coat Syndrome

WCS derives its name from the traditional white coats worn by medical professionals. The mere anticipation of a blood pressure reading or anxiety about being in a medical environment can cause some individuals’ blood pressure to surge. It’s crucial to understand that while this increase might be temporary, it can sometimes blur the lines when diagnosing hypertension.

How WCS Muddies the Waters of Hypertension Diagnosis

The primary challenge posed by White Coat Syndrome is its potential to lead to misdiagnosis. A patient might exhibit signs of hypertension in the doctor’s office but maintain regular levels outside. Such discrepancies can lead to:

Over-diagnosis: Patients might receive treatment for hypertension, including medications, even when they don’t need them.

Underestimation: Conversely, some might brush off genuine hypertension symptoms, attributing elevated readings solely to WCS. This can delay necessary treatment.

Why Singaporeans Should be Vigilant

Singapore, with its fast-paced urban lifestyle, has seen a steady rise in hypertension cases. Given this backdrop, accurate diagnosis becomes paramount. Being aware of WCS can aid Singaporeans in actively collaborating with their healthcare providers to ensure that they get the most precise assessment of their blood pressure.

Differentiating Between WCS and Genuine Hypertension

To make an accurate distinction between WCS and real hypertension, healthcare providers might:

Multiple Readings: Conduct multiple readings during a single visit to check for consistency.

Home Monitoring: Encourage patients to monitor their blood pressure at home and share those readings.

24-hour Monitoring: In some cases, a 24-hour blood pressure monitoring might be recommended to get a clearer picture.

Mitigating White Coat Syndrome

While WCS is a natural response, there are ways to reduce its impact:

Relaxation Techniques: Deep breathing and relaxation techniques before a medical appointment can help.

Familiar Environment: If possible, finding a regular practitioner or clinic can help create a sense of familiarity, reducing anxiety.

Open Communication: Discussing concerns about WCS and hypertension with the healthcare provider can ensure they consider it when assessing readings.

In Conclusion

Hypertension remains a significant concern for many in Singapore. While White Coat Syndrome poses challenges in diagnosing and managing this condition, being informed and proactive can ensure that one receives accurate care. Recognizing and understanding WCS can guide Singaporeans in their journey towards optimal heart health, ensuring that the readings on the monitor reflect their genuine health status and not just a fleeting moment of anxiety.


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About Dr Adrian Mondry

Dr Adrian Mondry is a Hypertension Specialist accredited by the German Hypertension League in Singapore. He was previously a senior consultant in the department of medicine at the National University Hospital and Ng Teng Fong General Hospital (NTFGH), Dr Mondry has more than 30 years of experience in the field of internal medicine.

Dr Adrian Mondry is recognised for his leadership and contributions in establishing the dedicated hypertension clinic within the National University Health System and fast-track deep vein thrombosis service at NTFGH.

Dr Adrian Mondry is fluent in English, German and French.

About Kaizen Medical

Kaizen Medical is located at Mount Elizabeth Novena Specialist Centre, Suite 11-57.

At Kaizen, we provide in depth health care to patients with multi-organs diseases; tackling undifferentiated presentations that cannot be easily assigned to a single organ.

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