Why In-Office Blood Pressure Checks Can Be Misleading

June 12, 2025

Older man having BP checked at doctors office

If left untreated, high blood pressure or hypertension greatly increases the risk of stroke, heart attack and heart disease. This is why doctors routinely check blood pressure at every visit and monitor for significant changes over time.

However, blood pressure readings can sometimes be misleading. For some people, blood pressure is much higher at the doctor’s office – commonly known as white coat syndrome. For others, blood pressure is lower than normal – a less common condition known as masked hypertension.

Michael Adornetto, MD, an internal medicine specialist at University Hospitals explains both conditions and how you can ensure your doctor gets an accurate blood pressure reading.

What Is White Coat Syndrome?

This occurs when a person’s blood pressure spikes in a medical environment, typically due to anxiety or nervousness. “When anxiety kicks in, your body releases stress hormones like adrenaline, which temporarily raise your heart rate and blood pressure,” says Dr. Adornetto. “However, these elevated readings don’t reflect a person’s usual blood pressure and often normalize outside of the clinical setting.”

White coat syndrome may be triggered by:

Fear of diagnosis. Worrying about potential health issues can send the nervous system into overdrive.
Unfamiliar environment. Sterile exam rooms, medical equipment and the formality of a clinical setting can feel intimidating.
Past experiences. Negative or uncomfortable experiences of past procedures can heighten stress.

Studies suggest that up to 20-30 percent of people with high blood pressure readings in medical settings may be the result of white coat syndrome, not hypertension. It’s more common in older adults, women and those with a history of anxiety. Misdiagnosis of high blood pressure can lead to:

Unnecessary prescriptions for blood pressure medications or other treatment recommendations.
Increased anxiety about your heart health. Repeated high readings can reinforce this fear and even lead to healthcare avoidance.

What Is Masked Hypertension?

“Masked hypertension is the opposite of white coat syndrome and is much less common,” says Dr. Adornetto. “A person has normal blood pressure in a clinical setting but really does have high blood pressure. It often goes undetected and untreated, putting the person at greater risk for serious health complications.”

Masked hypertension is more common in young men and those with high-stress lifestyles, who may find a clinical setting calm and relaxing in comparison to their daily routine.

How to Get an Accurate Blood Pressure Reading

If you worry that your blood pressure is artificially high or low in a medical setting, it’s important to share your concerns with your doctor. They may recommend the following to confirm or rule out a diagnosis of hypertension:

Home Monitoring. An approved blood pressure monitor is used at home to track readings over time in a relaxed setting. The readings are typically taken once a day, at the same time of day to monitor variations and spikes.
Ambulatory Blood Pressure Monitoring (ABPM). A portable device is worn that measures blood pressure periodically over 24 hours during daily activities.

If at-home or ABPM readings are consistently higher or lower than in-office readings, your doctor will determine next steps which may include:

Medications to manage confirmed hypertension.
Relaxation techniques like deep breathing to calm anxiety in medical settings.
Lifestyle modifications to improve overall health and manage blood pressure. These may include dietary changes, increased physical activity, weight loss, smoking cessation, and improved management of other medical conditions like diabetes or sleep disorders.