Blood Pressure and White Coat Syndrome
 

Dear all

Over the past few years my BP has been rising and last year I was put on medication to reduce it. I am monitoring it regularly at home and it is getting towards the normal range. However, whenever I go to a GP or AME it spikes quite a bit.

My GP has kept copies of my monitoring figures and is not especially concerned, as the meds seem to be keeping things under control. I am more worried about how the AME will view this, as last time he insisted on a letter from the GP after some weeks of monitoring.

Apart from losing a shedload of weight really quickly and taking up gym membership, what else can I do?

The best gym is the outdoors. I have the good fortune to live next to a river valley and my daily walk has me going up and down over varied terrain for 7 km. In other situations, I cycled or used rollerblades on off road pathways as much as possible. My last BP was 117/77. No meds.

Does it vary with the time of day? I tend to have it the highest late morning.

Same for me.

But now I'm just worried about the BP test and that is probably adding to the levels...

guys, your posts are not helpful. robin has white coat syndrome

I would hope you are writing your readings in a notebook. You should record date, time, 2 BP readings, pulse, and what you are doing (woke up, watching TV, just back from work etc)

Ask your GP to put his name stamp on it and perhaps just a note saying

In my opinion robin has white coat syndrome and these readings demonstrate to me he is normotensive

Not sure it will work, and this has come up before, but hopefully common sense will prevail. I would be more interested in the drugs you are taking....

Let us know how you get on

I have had WCS for 40+ years and it was a real problem trying to relax for each medical. My last medical was 15 years ago but recently when I had a pneumonia jab the nurse said it was very long since they checked my BP; of course, she found it "above normal". I took home a BP machine and for a week I recorded BP and pulse several times daily. The numbers looked a bit high to me but when I presented the readings to the nurse she did some black magic with her calculator and held up a large piece of paper with "124/77" on it - now, stop worrying!!!

Had the same problem, 24 holter B/P monitoring, with the prescribed medication came back within normal range, sat next to cardiologist far higher recording.

Yes it may well come to a holter, but a note book and Omron BP machine is £35. A holter and a report and a consultation is .........

I am trying to save OP throwing money away to prove the blinding obvious

I have very similar experiences. Yesterday I went for my annual visit to my optician. She has a brand new machine that photos the retina and flattens it out like an old fashioned map of the world so you can see everything like the blood vessels and optic nerve. Expensive test but she said it was worth it. Whilst reviewing the results (all was well) I mentioned that I had been hounded by doctors for 40 years about "high" BP. I asked her if it was possible to run high BP 24/7 for 40 years and have no effect on the picture we were looking at. Absolutely not was her reply. The eyes apparently cannot conceal genuine hypertension in a thing called the AV ratio. Next time you go to your optician and suffer from this ask them about it.

This white coat syndrome has plagued me throughout my career. I have had hospital stays and, after the initial tension, blood pressure goes to normal. Like you, I monitor it at home and it's always in the normal range. I've worked out my entire adult life and try to keep the weight down with a (mostly) healthy diet. Airline work is sedentary so it's important to get to the gym regularly. I refuse to be diagnosed or medicated for hypertension based on the relatively momentary nature of white coat. And I hate someone telling me to "relax." It's like telling someone to absolutely not think about oranges. If the livelihoods of these physicians and nurses depended on a physical every six months they might be as nervous as you and me.

So, back to your question. If you can, find an AME who understands. The best way I've found is word of mouth among airline pilots. When I displaced to a new location, I asked around. I also looked for somewhat out of shape guys to find out who they went to. I received a lot of wry smiles and some great information. The first AME I went to when I was new to the industry was recommended to me by a somewhat stout guy and I went to him for years. He understood. When he finally retired I went to the guy who replaced him who didn't understand. Because I had names of alternate AMEs I found one who I continue to go to. He understands. Good and experienced AMEs understand and pilots continue to go back to doctors like this. They understand white coat and that it doesn't constitute a threat to your own health or to the national airspace system. They have the big picture. No pilot wants to go to a "hard ass" AME. When an AME gets a bad reputation, pilot business likely suffers.

As an aside, linking your GP and AME together can be hazardous to your livelihood. Go to your GP for a health issue, go to your AME for your livelihood. May the twain never meet. I know, that's not always possible.

Best of luck on what I know is a worry and frustration. I walk in your shoes.

Just a bit of personal experience with the use of BP monitoring at home:

Doc wanted me to compare the accuracy of my device with her office device and asked me to bring in mine. In the office, as I sat in the exam room hanging off the edge of the table with the gizmo on my lap as I took the reading it was wildly inaccurate...didn't even make sense.

Bought a new machine and tried it at the doc's office again with same result. Sent it back to manufacturer (Omron) to be checked with result as normal function. But in my conversation with the customer service tech rep I was told you must follow the USE instructions EXACTLY...not just closely but EXACTLY or the reading is inaccurate.

Dangling off the edge of the doc's exam table just doesn't fit the operating instructions. I don't have white-coat hypertension or particularly high BP anyway.

Firstly, AME's definitely differ in their attitude. My original one used to joke with me about putting ancient pilots into a darkened room for 10 minutes before the ecg.
Secondly, try a few mind relaxation exercises. Plenty on the web these days, but I was taught one by a BA medic years ago which takes only a minute or so, but appears to work
THirdly, if BP is the issue, consider Beetroot juice (most supermarkets have it). Tastes pretty grim, but does lower my BP a few points if taken for a week or so before the exam, do make sure that it won't interfere with your medication.