The very presence in a hospital or sight of a doctor or needle causes blood pressure to spike in some patients Image Credit: Shutterstock

Dubai: Are you a victim of White Coat Syndrome? The condition seems to have received renewed focus during the pandemic when a number of UAE residents have reported a spike in their blood pressure during a visit to the hospital or primary health-care centre for either a PCR test or for their vaccination jab.

Dr Dirar Abdallah, Chair of Medicine and Consultant of Internal Medicine at Prime Hospital, said: “White Coat Hypertension (WCH) or White Coat Syndrome (WCS) are conditions that have been there for a long time and have been diagnosed as a disorder in which patients develop high blood pressure as soon as they enter a health-care facility and see a person (doctor or nurse) attired in a white coat.”

Dr Dirar Abdallah

He said, "More than 50 per cent of residents who walked into our clinics for vaccination have displayed classic WCH symptoms at least once or twice. We realised this when their blood pressure was recorded."

Dr Abdallah said the main symptom is a sudden shooting up of blood pressure. “However, we also diagnose it as a syndrome as in many cases, people have accompanying cardiovascular symptoms that include breathlessness, rise in heart beats per minute, palpitation, dryness of throat, confusion and even a fainting spell.

Are you having a panic attack?

Dr K. Arun Kumar, consultant psychiatrist at Aster Clinics and Hospitals, said: “People can either have a spike in blood pressure, which is WCH, or a complete panic attack, which is WCS, and a lot depends on an underlying anxiety condition that the patient may not be aware of.

Dr K. Arun Kumar

"The strong association of sickness, fear of getting medicines, doubts about vaccination safety etc, evoke an anxiety response. This triggers neurotransmitters to release adrenaline and/or epinephrine hormones. These increase the heart rate and blood pumping from the heart and can also increase blood pressure and help break down fat and increase blood sugar levels to provide more energy to the body. However, such a response is a manifestation of WCS or WCH.”

Dr Abdallah said the vaccination campaign has been a blessing in disguise as it has helped people discover their hypertensive conditions. Earlier, if hospitals were routinely checking blood pressure of 1,000 patients each day, then, during the vaccination campaign, we are checking blood pressure of more than 20,000 patients and that has helped highlight the problem.”

Vaccine on eighth attempt

Take the case of Sundaresan (name changed on request) who was able to finally get his COVID-19 vaccine on the eighth attempt, only after he consulted the hospital psychiatrist.

Highlighting this case as a classic example of WCH, Dr Kumar said: “It took Sundaresan nearly two months to get his first dose of COVID-19 vaccine. Every time he entered the clinic, he felt breathless, started having breathing difficulties and his blood pressure shot up. He was turned away at least seven times. He had no history of blood pressure and had a normal blood pressure reading otherwise. Sundaresan’s entire family of five got vaccinated, but he was struggling — until he decided to consult me. Usually, people with WCS have a deeper or underlying anxiety issue that finds a vent in this situation. What I did was address those fears and anxiety and calmed him down over a few weeks. In some cases, people may require anxiety medication or counselling sessions before they are able to take the jab.”

Difference between WCH and routine hypertension

Dr Alaa Zedan, specialist internal medicine at Burjeel Hospital for Advanced Surgeries further explained the condition. “Hypertension, per se, is a medical epidemic sweeping through the world. One of the biggest gains from the national vaccination drive has been the detection of undiagnosed hypertension as blood pressure screening has been made mandatory before getting the jab.”

Dr Alaa Zedan

He said: “Typically, those who suffered a rise in their blood pressure prior to getting vaccinated were those who presented with a systolic blood pressure of above 140 and a diastolic reading of 90 or above. In many cases, residents were asked to rest, relax and return later and many were able to bring down the blood pressure.”

Diagnosing those with routine hypertension

Dr Zedan continued: “Some were asked to proceed for further tests and it was discovered that they actually had routine hypertension. However, those with a psychological response to the fear of vaccination found that their blood pressure spiked only during this period. Doctors put many patients on ambulatory blood pressure reading (which a 24x7 constant pressure reading for a week) to understand whether the spike was only during the time of vaccination.

Tips to handle WCS and WCH
• Initially, removing the patient from the source of anxiety, getting him or her to calm down, letting him or her have some water and counselling can help. Many patients who had a high reading in the first attempt were able to get a regular reading after three attempts and could take the vaccination.
• It is recommended that people routinely do a blood pressure check with a monitor at home every day to get used to the monitoring and not panic when they are tested at the vaccination centre. It will help them be calmer.
• Practise regular breathing, meditation and relaxation exercises to maintain an even composure — especially in these pandemic times when loss of jobs, job insecurity, fear of getting infected are major stressors resulting in a spike in blood pressure.
• It is advisable to cut back on processed food and high sodium food items such as pickles, preserves, cured meats, readymade sauces and dressings that have hidden sodium content that result in induced hypertension.
• Eating nutritionally balanced food and exercising at least 45 minutes a day can help keep body weight under control as unhealthy lifestyle is a major trigger for hypertension in younger people. Such measures not only help a routine hypertensive patient, but also those who suffer from WCS or WCH.

"All this gave us a clear idea that some patients needed medication, some needed a consultation on nutrition and fitness as they had ruined their health with high-sodium food and a sedentary lifestyle in the new Work From Home routine, while a percentage of them suffered from WCS. The vaccination campaign has given us an opportunity to diagnose and categorise people into routine, occasional and lifestyle-related hypertension. The first category needs medication, the second may require just calming down or counselling, while the third needs major life-style tweaks.”

Shukhran Dubai

A first person account by C. Sunil Roy, a Dubai-based advertising professional

Dubai: The reminder about my vaccine appointment flashed when I opened my DHA app which was soon followed by an SMS and an email. I couldn’t help but feel comforted to know that I am all set to take my second dose. The reminder came with no follow up from my side. It showed that I was cared for as an individual. It showed that the government cares for you, whether you are a citizen or an expat. It showed a commitment to fight the virus without any compromise.

We have seen the tremors on account of the pandemic being felt across different regions. While my friends from various parts of the globe have their own two bits to add, I thought it was time for me to express my thanks for the efforts being taken by the Dubai Government to meet the challenges head-on, based on my experience and the experiences shared by others to me.

When the vaccination drive started, my wife and I decided to get vaccinated. Right from my first call to the DHA till we got the jabs, it was a comforting experience. My heartbeat has the funny habit of getting into the acceleration mode every time my pressure is checked and this time too, it was no exception. It was on an F1 mode, throbbing ahead as if to catch the checkered flag. And that was the time when the comforting voice of the supporting healthcare staff made a big difference.

A breathing exercise was suggested and I was given the opportunity to relax and that too, when many were waiting for their turn. Maybe, it was their comforting voice or their positive attitude. Whatever it was, it made a difference and my heartbeat got back to its normal rhythm and I was ready for the jab.

Excellence is a way of life

Minutes later while driving back home, I was full of gratitude for the perfect system that was in place which made it possible for us to get the vaccine. I can never forget the ever-smiling face of the healthcare professionals who are there to ensure that there was no hiccup at any stage and above all, their humane approach. When I shared my experience with few friends who got themselves vaccinated at different centres, they also echoed the same feeling. This only reinforced my belief that in Dubai, excellence is a way of life. We owe it to the authorities and the healthcare and support service workers for their efforts to make Dubai as safe as possible for each one of us.

A few weeks back, a friend of mine tested positive for COVID-19. When she shared her experience, it again strengthened my belief in the system that is in place. By the time my friend got her result, it was close to midnight but the caller from DHA assured prompt help and support when she requested for institutional quarantine. Within an hour, a taxi picked her up and soon she was made to feel as comfortable as possible in a place that though made her miss her home, came as close as possible. Being a lady, she was initially scared to take up institutional quarantine. But then, the reassuring voice of the caller and the subsequent interactions provided an experience wrapped in hope, positivity and goodwill. Not to forget the regular monitoring provided by the doctors and healthcare professionals at the centre.

The authorities have paid attention to a diverse range of aspects in order to ensure a hassle-free experience. Right from ‘entry with appointment’ to ensure that there is no crowding at the vaccination centres, social distancing protocols, scheduling that enables to minimise the waiting time and get the jab done within minutes, regular sanitisation, washroom facilities and even providing water bottles to those who need them, proper care and attention have gone into each and every aspect. No wonder many like me experienced a worry-free vaccination experience.

From the depth of our hearts, we say Shukran Dubai.