Many people who have normal blood pressure experience anxiety-induced spikes in the doctor’s office that can give the impression of hypertension, or white-coat hypertension. It is considered somewhat common.  If you think you are in that category, you should first establish whether your suspicion is indeed correct, said Dr. Sheldon G. Sheps, an emeritus professor of medicine at the Mayo Clinic.  Blood pressure can rise or fall throughout the day depending on a number of factors. So doctors recommend that you take multiple readings under normal circumstances to get a good idea of your blood pressure outside the clinic.  If you are checking your blood pressure at home, for example, do it in the early morning or evening, and don’t eat or exercise directly beforehand. Take a seat in a comfortable chair for a few minutes with your legs uncrossed and your upper arm at heart level. Take three readings at intervals of one minute or longer, then calculate the average. Do this once or twice a day over several days to get a more accurate picture.  At the doctor’s office, an average reading of 140/90 or greater is considered Stage 1 hypertension. At home, however, the upper limit of healthy blood pressure is considered to be 135/85.  In the past, white-coat hypertension was often dismissed as not very serious. But now research suggests that as many as half of all people who exhibit the phenomenon eventually develop the real thing.  “Most of us think that it does progress to established hypertension over time,” Dr. Sheps said.  There is evidence that in elderly patients who exhibit white-coat hypertension, blood pressure medication can reduce the likelihood of cardiac events, Dr. Sheps added. But for the average person, medication is probably not immediately necessary.  It is better to start with other measures that can lower blood pressure, like losing weight, cutting back on alcohol and increasing exercise. Continue monitoring your blood pressure to see if these changes make a difference, and work with your doctor to determine whether you might eventually need to take medication.
A reader asks whether white-coat hypertension &#8212; the tendency to develop high blood pressure at the sight of a doctor&#8217;s garb &#8212; is common and dangerous.