What Is White Coat Syndrome?

Written by Nicole Schmidt
Medically Reviewed by Shruthi N, MD on May 27, 2025
8 min read

White coat syndrome (also called white coat hypertension) happens when your blood pressure goes up at the doctor’s office, but is normal when you’re at home. The name comes from the white coat that doctors often wear. Just being in a medical environment can cause stress or anxiety for some people, which can lead to a temporary spike in blood pressure. 

Several studies have confirmed that white coat syndrome is real. It’s estimated that between 15% and 30% of people who have high blood pressure at the doctor’s office actually have white coat hypertension. 

Getting an accurate blood pressure reading is important because it helps your doctor decide whether you need treatment. If your blood pressure reads as too high, you might end up taking medication you don’t actually need, or the wrong dose. But if your blood pressure is only high in medical settings, you may not need medication at all — just ways to help you manage stress and anxiety.  

Jordana B. Cohen, MD, associate professor of medicine at the hospital of the University of Pennsylvania who has studied white coat hypertension, says there are several reasons why your blood pressure might be higher at the doctor’s office. One of the most common problems is not resting for three to five minutes before your reading. “It's very normal that your bus was late or traffic caused an issue. If you're running to your appointment, there’s often no time for that three- to five-minute rest,” Cohen says. Other small factors, like having a full bladder or drinking coffee before your reading, can also push your numbers up temporarily. 

Even the way your blood pressure is taken can affect the result. Cohen notes that the position of your arm, whether your feet are flat on the floor, and the size of the cuff can all change the reading. “If you have larger arms or your arms are shaped differently than the average person, the cuffs themselves can end up causing a mismeasurement that falsely elevates your blood pressure,” she says. 

White coat syndrome can happen to anyone, but it’s more likely to affect people who:

  • Are over the age of 50 
  • Are female 
  • Have obesity  
  • Already have high blood pressure
  • Don’t smoke or use tobacco products 

Is white coat syndrome caused by anxiety?

For some people, simply being at the doctor's office causes anxiety. When you feel nervous, your body releases stress hormones that make your heart beat faster and raise your blood pressure. Even things like seeing medical equipment or being around doctors can trigger that same stress response. But this is just temporary. “It doesn't represent what your blood pressure is during the 99.9% of your life that you're not in the doctor's office,” Cohen says. 

How serious is white coat syndrome?

White coat syndrome usually isn’t serious on its own, but it can still affect your long-term health. Researchers have found that people with undiagnosed white coat syndrome have a slightly higher chance of getting heart disease and related complications. If you have diabetes or a history of a heart attack, white coat syndrome may also raise your chances of long-term heart problems. The same goes for masked hypertension — a condition where your blood pressure is normal at the doctor’s office but is actually high during your daily life. 

Both white coat syndrome and masked hypertension can also make it harder for your doctor to know whether you actually have high blood pressure. Catching it early can help you avoid unnecessary medication or make sure you’re taking the right dose. 

If you’re already taking medication for high blood pressure, having a higher reading at the doctor’s office doesn’t raise your chances of getting heart disease. 

A normal blood pressure reading is usually less than 120 over 80. The first number measures the pressure in your arteries when your heart beats and pushes blood through your body. The second number measures the pressure when your heart relaxes between beats. If your reading is higher than 130/80 at the doctor’s office but within the normal range while you’re at home, you may have white coat syndrome. The most common symptom is feeling nervous or anxious at the doctor’s office. That feeling might get worse when you enter the exam room to have your blood pressure checked.

Diagnosing white coat syndrome usually involves checking your blood pressure at home so your doctor can compare the readings in different settings. There are two main ways to do this:  

  • 24-hour ambulatory monitoring: This test involves wearing a small blood pressure monitor for a full day. It automatically checks your blood pressure every 15 to 30 minutes during the day and every hour at night. This gives your doctor a better picture of what your blood pressure is like during your regular day-to-day routine.
  • Home monitoring: Your doctor may ask you to check your own blood pressure at home using a reliable monitor. You’ll record your numbers over a few days or weeks and bring them to your next appointment. 

If you’re checking your blood pressure yourself at home, Cohen recommends using the Validate BP website to make sure your device is validated. Your doctor can walk you through how to use the monitor correctly. 

Cohen suggests checking your blood pressure at least twice a day — preferably in the morning when you wake up and before you go to bed. Each time, you should take two readings back-to-back. “People with white coat hypertension are more susceptible to something called the ‘alerting reflex,’ which is where your blood pressure rises when the cuff goes off and you get a little bit anxious,” Cohen says. The second reading, she adds, is usually more accurate. 

If you have at least three in-office readings that are higher than your at home readings, your doctor can diagnose white coat syndrome. 

If you don’t have other risk factors for heart disease — like obesity or smoking — talk to your doctor about ways to feel more relaxed during your appointments. Some clinics have automated blood pressure monitors, which can take your reading when you’re alone and may help lower anxiety. These aren’t available everywhere, but it’s worth asking. 

If you’ve been diagnosed with white coat syndrome, Cohen recommends checking your blood pressure regularly at home — ideally at least three days each month. 

“The best you can do is collect this data, know your numbers, and be aware of your own risk,” she says. If your numbers are consistently normal at home, you don't need to be treated. But if they start creeping up, that’s when you should talk to your doctor to make sure it isn’t turning into something more serious. “Empower yourself and take it into your own hands because you're your best advocate,” Cohen says. 

If you do have other risk factors for heart disease, your doctor may suggest lifestyle changes like exercising more, losing weight, cutting back on salt, or quitting tobacco.  

Can you outgrow white coat syndrome?

There’s no official cure for white coat syndrome. Some people continue to feel anxious at the doctor’s office for years — even with a doctor they know and trust. But there are steps you can take to feel more at ease during your visits and get a more accurate blood pressure reading.

How do you calm down when you have white coat syndrome?

If you tend to feel nervous during doctor's appointments, it can be hard to stay calm during a blood pressure test. But the following tips might help:

  • Choose a doctor you feel comfortable with. If your current doctor makes you feel uneasy, try to look for someone who’s a better fit. 
  • Come prepared. Write down any questions or concerns before your appointment. Being organized can help you feel more in control and less nervous about forgetting something important.  
  • Give yourself plenty of time. Try to arrive early so you’re not feeling rushed or flustered when it’s time for your blood pressure check.
  • Ask for a few minutes of rest before your reading. Use that time to take a few deep breaths and try to relax your body. 
  • Avoid coffee, smoking, or exercising before your visit. These things can raise your blood pressure temporarily. 

White coat syndrome is a fairly common condition where your blood pressure goes up at the doctor’s office but is normal at home. It’s often caused by stress or anxiety and usually isn’t dangerous, but it can make it harder for your doctor to get an accurate blood pressure reading. If you think you might have white coat syndrome, tracking your blood pressure at home and sharing those numbers with your doctor can help them decide if you actually need treatment. Once you’re diagnosed, small changes — like getting enough rest, skipping caffeine, and taking a few deep breaths before your reading — can help you feel more at ease and get a more accurate result.

How do you stop white coat syndrome?

You can’t always stop white coat syndrome completely, but there are ways to manage it. Try to avoid things that raise your blood pressure before your appointment, like coffee and exercise, and be sure to rest for a few minutes before your reading. 

Is white coat syndrome dangerous?

White coat syndrome usually isn’t dangerous on its own, but a small number of people who have it also have a slightly higher chance of getting heart disease — especially if they have other health issues, like diabetes.

How much does white coat syndrome raise your blood pressure?

Normal blood pressure is 120 over 80. If your reading is more than 130 over 80 in the doctor’s office but normal at home, you may have white coat syndrome.

Do doctors believe in white coat syndrome?

Yes, doctors recognize white coat syndrome as real. If your doctor suspects you might have it, they may recommend monitoring your blood pressure at home to confirm the diagnosis. 

Can obsessing over blood pressure raise it?

Yes, worrying too much about your blood pressure can make you feel nervous, which can raise your numbers. 

Should I tell my doctor I have white coat syndrome?

Yes, let your doctor know if you get nervous during appointments or think you have white coat syndrome. They can help you track your blood pressure more accurately and find ways to make visits less stressful.