White Coat Fear Can Falsely Raise Blood Pressure in Teenagers, Study Finds

The white coat effect blood pressure phenomenon can significantly distort blood pressure readings in children and teenagers, potentially leading to unnecessary medication and long-term anxiety. A major joint study by medical institutions in India and the United States has highlighted that a single high blood pressure reading in adolescents should not be treated as a confirmed diagnosis.
Experts warn that stress, fear of doctors, and unfamiliar clinical environments can temporarily elevate blood pressure—especially in young patients making repeated measurements essential before labelling a child hypertensive.

What the Study Found

The study was jointly conducted by experts from AIIMS Bhopal, Puducherry Medical College, Noida Medical College, and the University GME Consortium Residency Program in Cottonwood, USA.
Researchers found that adolescents who show high blood pressure in a single reading often return to normal levels when measurements are repeated over time. This temporary rise is known as the white coat effect.

Why High BP in Teen Years Matters

Doctors caution that consistently high blood pressure during adolescence can turn into permanent hypertension in adulthood. This may lead to serious complications such as heart ailments, reduced kidney function and other problems.  Because of this risk, many teenagers begin medication early, sometimes unnecessarily based on just one abnormal reading.

Key Findings From Bhopal Schools

As part of the study, researchers screened over 800 healthy students from government and private schools in Bhopal, aged 10 to 18 years. In the first screening 4% showed high blood pressure, second screening (after a few days) showed 2.7% and the hird screening showed only 1.9% cases of high blood pressure. The sharp decline clearly showed that anxiety and situational stress inflated initial readings.
Doctors emphasised that three separate checks, spaced over time, are crucial for accurate diagnosis.

What Causes Temporary BP Spikes in Children

According to experts, blood pressure in children is naturally unstable and highly sensitive to surroundings. Several factors can raise readings temporarily:

• School environment stress
• Exam pressure
• Fear of doctors
• Medical instruments
• Unfamiliar clinical settings
• This is why the study measured blood pressure on three different days, each a week apart, and took three readings per visit.

Boys Show Higher Risk Than Girls

The study revealed a clear gender difference. High blood pressure appeared more frequently in boys.  Doctors link this to hormonal changes, fat distribution, and higher physical and mental stress among adolescent boys.

Normal-Weight Children Are Not Immune

Contrary to popular belief, the study found that normal-weight children can also have high blood pressure. Several students with normal BMI still fell into the high BP category. This finding highlights that weight alone should not determine whether a child’s blood pressure is checked.

Long-Term Dangers of Ignoring Adolescent Hypertension

Doctors warn that untreated high blood pressure during teenage years can quietly damage organs. Early intervention through lifestyle changes—such as physical activity, reduced screen time, and stress management—can prevent lifelong disease.

What Raises Permanent Blood Pressure

Doctors listed several long-term risk factors:

• Age progression
• Obesity
• Insulin resistance
• Overactive nervous system
• Salt imbalance
• Hormonal changes
• Blood vessel structure changes
• High uric acid
• Genetics
• Poor nutrition during pregnancy

ABPM: The Best but Limited Tool

The study noted that Ambulatory Blood Pressure Monitoring (ABPM) which tracks BP over 24 hours is the most accurate method. However, limited availability and lack of Indian reference data make it impractical for routine use.
For now, repeated manual BP checks remain the most reliable option.

Doctors Stress Repeated Testing

Doctors Amit Kumar (Community Medicine) and Girish C. Bhatt (Paediatrics) from AIIMS Bhopal played a key role in the research. They stress that measuring blood pressure at least three times on different days prevents misdiagnosis caused by anxiety-related spikes.
Their conclusion is clear that one high reading does not equal disease.

White Coat Fear

White Coat Fear, also known as White Coat Hypertension (WCH), is a genuine medical phenomenon in which anxiety experienced in a clinical setting leads to a temporary rise in blood pressure, especially in children. The presence of doctors, medical equipment, or even the sight of white coats can trigger stress, causing BP readings to appear high during clinic visits while remaining normal in everyday settings such as at home. This reaction reflects the body’s natural stress response and may be accompanied by signs like sweating, restlessness, nervousness, or clinging to parents. Because these elevated readings are situational and not persistent, doctors stress the importance of monitoring blood pressure outside the clinic to prevent misdiagnosis and ensure that children receive appropriate and necessary care.