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‘White-coat syndrome’ or high blood pressure?



DEAR DR. ROACH: My 21-year-old son is a college athlete, a sprinter, but he has had recurrent high systolic blood pressure readings since he was a senior in high school. He’s generally easygoing and not stressed. Doctors always attribute the elevated results to “whitecoat syndrome,” since he is otherwise in excellent health and doesn’t drink, smoke or use drugs. The last reading was 142/78, when he checked it at a drugstore monitor.

He’s never had any reason to be nervous in a doctor’s office, and the initial high reading was with the same pediatrician he’d been seeing all his life. Once, a nurse had him rest quietly for a few minutes and rechecked the reading; it was lower, but still high. He just finished four months of rigorous basic training with the Army with no problems ( his high reading on his physical was put down to nervousness), and he may now be anxious no matter where or when the reading is taken, but I’m worried that something else may be going on. Is there something we should have checked? — K.C.

ANSWER: The real question is whether your son has “white coat” hypertension, or just hypertension. The best way of answering this is with a 24-hour blood-pressure monitor, which checks the blood pressure every 15-30 minutes while awake, and less frequently at night. If those readings are mostly in the normal range, we could conclude that he has reactive, or white-coat, hypertension.

However, it is possible that he has hypertension. Healthy young people sometimes get hypertension, and he may be able to get his blood pressure down without medication, through salt reduction and relaxation techniques. But if he needs them, there are medications that will not affect his athletic abilities.

I sometimes order an echocardiogram to look for changes in the heart that go along with high blood pressure. However, the elevated blood pressure readings are only of a few years’ duration, so he might not have these yet. I think the 24-hour BP monitor is the way to go.

High blood pressure is one of the most common ailments for the general population. The booklet on it describes what it does and how it’s treated. Readers can order a copy by writing: Dr. Roach — No. 104W, Box 536475, Orlando, FL 32853- 6475. Enclose a check or money order (no cash) for $4.75 with the recipient’s printed name and address. Please allow four weeks for delivery.


DEAR DR. ROACH: Is there much difference between D. O. degrees and doctor of medicine degrees? I just noticed that my PCP has a “D.O.” after his name, and nothing else. — B.B.

ANSWER: A D. O. is a doctor of osteopathy, someone who went to an osteopathic medical school. D.O. physicians are licensed to practice medicine and surgery in all U.S. states; in Canada, licensing varies by province. The training of an osteopathic physician is similar to that of a doctor with the M.D. degree, but osteopathic physicians obtain training in osteopathic manipulative medicine.

It has been my experience that D.O. physicians are very similar to M.D. physicians, in most respects.

Readers may emai l questions to ToYourGood- Health@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to P.O. Box 536475, Orlando, FL 32853-6475.

©2014 North America Synd.

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