When I was in pharmacy school, we learned and were subsequently certified to take blood pressure–the precise way to take blood pressure.  It’s a two-fold method, where you have to pump up the cuff two different times and noting when the pulse disappears and reappears on the first go.  Really, it’s long and complicated, and there are shortcuts, but this was a) school and b) pharmacy school, where we’re taught to check, recheck, and be as accurate as possible by adhering to systematic processes at the outset.  It’s no wonder I border on obsessive precision disorder.

When I settled into a new town at about 10 years into my career, I decided to establish care with a physician.  I was relatively young and didn’t have any major problems, but it’s still a good idea.  The nurse checking me in took my blood pressure.  It was elevated above the point where you need to treat it.  For me though, it was way higher than it had ever been.  In school when we practiced taking each other’s blood pressure, mine was typically around 100/70.  How could it be so high now?  Sure, I had gained weight since then and had just left a very stressful job in search for a more balanced existence, but I had also started running, losing weight, and eating better.  My physician and I agreed to just keep an eye on it and get a home blood pressure monitor.  Okay, check.  Follow-up in 6 months….  Umm, we’ll see.  I’m not a good follower-upper where my own health is concerned.

Several months later I went to the dentist. With adults I guess they take more precautions.  I admit it had been about 7 years since my last dental appointment.  They took my blood pressure.  It was high!  More than a little high.  Almost stroke range high.  Seriously?  I had been checking at home, and it was what I expected–120s/80s and lower especially right after a cardio workout.  The answer had been confirmed for me.  Yes, I had White Coat Hypertension.1

Well, the dentist, a seemingly caring man about my age, asked me about my life, stresses, hobbies, etc.  I thought he was just trying to get to know me and calm me down, but, no.  He was gearing up to give me advice on my blood pressure because he would not be able to work on me with it that high.  Yes, stress can do a lot of bad things, but he proceeds to tell me a good way to handle stress is exercise.  Did he not just hear me tell him that I ran a half-marathon a few months ago?!  I exercise.  Furthermore, I know these things. I’m in the healthcare biz.

I followed up with my physician a few weeks later to tell him the saga.  I brought my home machine and showed him my numbers, including the one I took right after the dental visit because my blood pressure had stayed elevated for 2 hours afterward.  Typical for WCH. We agreed, yes, it’s White Coat Hypertension (read: you get really, really anxious at dr’s offices, and your adrenaline starts pumping), and perhaps something should be done.  At work I spend my entire day around white coats.  I work in a hospital.  With physicians, nurses, pharmacists, mid-level practitioners, etc.  How could I have this White Coat Nuttiness?

It’s simple.  I’m human.  I’m afraid of being judged, evaluated, criticized.  I had done all the right things by changing my job, my lifestyle, my diet, my weight.  I’m still afraid of someone discovering a disease, uncovering an ugly truth, shining a light on something inside that I don’t want to know.

Well, the result?  I got a prescription for a blood pressure pill.  Regardless of the cause of my hard-pounding vessels, that trauma to my vasculature and vital organs will eventually lead to badness.  Treatment. Prevention.   …but I have yet to return to the dentist.  Bad patient.

  1. Shimbo D, Abdalla M ,Falzon L, Townsend R, Muntner P. Role of Ambulatory and Home Blood Pressure Monitoring in Clinical Practice: A Narrative Review. Ann Intern Med. 163(9):691-700.

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