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Have white coat hypertension. Family history of cardiac disease. Worried for high BP. Prognosis?

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Cardiologist, Interventional
Practicing since : 1995
Answered : 141 Questions
Respected Sir,

I am - Male / 35 Years – BMI – 25.2 kg/Cm2

I observe that I have XXXXXXX WHITE COAT HYPERTENSION" : As I walk in to any physician in any event like Pre-employment / Routine / Insurance check up ; when he or she measures BP using mercury meter , mine remains always on upper side say – 150/100 mm Hg.

However, when I myself measure at very calm and resting condition in late evening at my home by using my home digital bp monitor ( Make : Omron ) it remains average : 120/70 with pulse rate of 58-62 bpm. Which is almost stable and consistant all days. My meter is regularly calibrated by company as per Govt. Norms. ( attached recent calibration certificate)

While my regular bp moniting at home i observed that when my pulse reminas low < 60 bpm my SBP usually remains high or vice a versa. Plz. Clarify is it suppose to happen !!!

I become over altert and over conscious while some one meausres bp and it always reminas high however it is not happening with my self home measurement.

Even through for self satisfaction or like placebo effect I am taking 1.25 mg/OD of Nebivolol since last 2 years. Also takng an aryuvedic medicine called ( MUKTAVATI – Patinjali ).

I have cardic disease history in my family. My father died at 56 years in a complications in by-pass surgery and RV failure. My grand father too at 68 years.

I have mild hyperthyroid ( Autoimmunie Graves Thyrotoxicosis) diagnosed before 2 years , however the all thyrid hormones are well controlled thrughout without or with minor doses of antithyroid drugs.

Just for mental satisfaction and doubt clear , I was hospitalized for 2 days and undergone ambulatory bp monitoring ( avg. 130/80) same time

I had also undergone Angiography and Echo doppler , which seems to be absolutely normal - In a repurted hospital of Vadodara-Gujarat. Also Several time i had undergone ECG and 2 -3 times TMT how ever they seems to be normal.If you want i can forward reports for your reference.

My blood reports related to Lipid Profile / HbA1c / Thyroid and others are usually seems to be normal. ( attached report.pdf)

My high bp with mercury meter at physician table make be panic and guilty in front of others. And also threat me as my heridity is of cardic events.

I request you to suggest

Is any more diagnosis required ?
Is any treatment or alternative therepy to follow ?
Is any medicines which may help this conditions.?

Best Regards,
Posted Fri, 1 Mar 2013 in Hypertension and Heart Disease
Answered by Dr. (Prof.) Subroto Mandal 54 minutes later
Hello and welcome

I have gone through all details and in my opinion looks like you are more anxious about your health.
Definitely it is better that you always take care of your health.

Secondly As per your records and your history regarding "white coat hypertension" it may be but even i suggest that you should check your BP in a regular interval and if raised continue for medication.
Normally this automatic BP machine gives avarage BP recordings but to diagnosed either you are a hypertensive or not you have to go to a physician/cardiologist.
In many occasion we see this type of problems in young hypertensive or border line cases.
All other your reports are OK you can continue with thyroid treatments.
Hope I have answered your query. For any other clarification please write to me.

Wish you healthy heart

Above answer was peer-reviewed by
Follow-up: Have white coat hypertension. Family history of cardiac disease. Worried for high BP. Prognosis? 19 hours later
Respected Sir,

Thank you for your response on query.

Yes, i am over alert for health after the death of my father and in threat due to heridity problem.

Yes , in past i was on anxiety medicine i.e. ( Escitalopram or Alazopram ) for some time but now i have discontinue as per advise.

I do agree that i should have regular bp monitoring with physician, but the problem is that every visit i found higher bp so as per physician i am hypertensive. But not with my home monitors.

Anyway I am on 1.25 mg/OD Nebivolol , is this ok for the kind of situation ?

Should I change the medicine or dose ?

What could be the possible side effects of the above kind of medicine i am consuming.

Is the digital automatic home monitors ( like company Omron) is reliable , how can we relate it with the mannual mercury bp monitors.

Is there any alternative method to find , weather hypertensive or not other than a conventinal mercury meters ?

Attached my report of Angiography and Echo Doppler for your information to evaluate overall cardiac health

Answered by Dr. (Prof.) Subroto Mandal 1 hour later
Hello and welcome,

First of all, it’s nice that you have stopped anxiety medicine. Regarding nebivolol you should continue with same dose till your BP maintains normal level.

Normally nebivolol has very less side effect. In addition, sideeffects affect mainly during old age hence do continue the medicine.

Digital BP monitor is good for follow up; it gives good BP records and measurements in home.

You can check your blood pressure with that automatic machine but if you found something very very unusual consult your physician.
I have gone through your angiogram and Echocardiography report, which is normal. So do not worry and be happy continue medication and regular exercise.

Wish you healthy heart & Life

Above answer was peer-reviewed by
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