“WHITE COAT SYNDROME”: INJURED WORKERS WITH HIGH BLOOD PRESSURE AT EXAMINATIONS AND EVALUATIONS:  HYPERTENSION, WORKERS’ COMPENSATION, AND INJURED WORKERS: WHAT YOU NEED TO KNOW

Practically everyone is nervous when they have to see a Doctor for either a medical appointment or evaluation.

Injured Workers are especially nervous when they attend treatments or evaluations.   Besides health concerns, Injured Workers are worried about whether the medical appointment or evaluation will impact their claim for workers’ compensation benefits.  In sum, medical appointments and evaluations can be a source of anxiety.

In Workers’ Compensation, during the course of many medical appointments or evaluations, Injured Workers have their blood pressure taken.   Sometimes, an Injured Worker’s’ blood pressure is elevated.  In circumstances where the Injured Workers does not have underlying high blood pressure or hypertension, Physicians may label the high blood pressure reading as “White Coat Syndrome” (WCS) reading or “White Coat Hypertension.”

This article will discuss “White Coat Syndrome,” Why is it important? and How It Can Impact a Workers’ Compensation Case.

What Is an Example of “White Coat Syndrome”?

An Injured Worker with an industrial back injury, attended their Orthopedic Qualified Medical Evaluation.  Other than the back injury, she was in good health and had no prior history of hypertension.  The Injured Worker, at the time of the evaluation, was nervous because she had never been to that doctor’s offices before. The nurse, in the office, took her blood pressure and recorded it.

After the evaluation, the QME report was issued.   The documented that, at the time of the evaluation, the Injured Worker had a blood pressure of 150/100.

What Is “White Coat Syndrome”?

“White Coat Syndrome” occurs when someone who is untreated for blood pressure presents at a medical office setting with an elevated blood pressure.  When the Individual is outside of the medical office setting, they have normal blood pressure.

“White Coat Syndrome” is considered clinically significant if the difference between the medical office setting the out of office blood pressure exceeds 20/10 mm/hg.  This means that you add 20/10 to a blood pressure reading to make the determination. Therefore, someone with 120/80 [a normal blood pressure] would have significant WCS if they tested 140/90, in a clinic.  140/90 is considered as an elevated blood pressure that, if sustained, would be considered as hypertension.

What Is the Cause of “White Coat Syndrome”?

The cause of WCS is controversial to the extent that there is no definitive statement concerning it. Anxiety has been suspected. An example of stress that can trigger an elevated blood pressure is public speaking can trigger an episode. Sometimes, there are psychosocial stressors that can come into play.   In essence, something in an Injured Worker’s past may trigger the elevate pressure. Current status of white coat hypertension: where are we? Gani NurediniAlec Saunders*Chakravarthi Rajkumar, …First Published June 24, 2020 Review Article https://doi.org/10.1177/1753944720931637

Why Is “White Coat Syndrome” Important For Injured Workers?

A finding of White Coat Syndrome is of concern for Injured Workers.   It may be an indication that the Injured Worker needs to have a cardiovascular work-up.  “White Coat Syndrome” may be an indicator for the development of sustained hypertension, target organ damage, and possible occurrence of cardiovascular events. Current status of white coat hypertension: where are we? Gani Nuredini*, Alec Saunders*, Chakravarthi Rajkumar, …First Published June 24, 2020 Review Article https://doi.org/10.1177/1753944720931637

Can “White Coat Syndrome” High Blood Pressure Be A Mistake?

When evaluating “White Coat Syndrome”, it is important to determine whether the Blood Pressure reading was in fact accurate.   There are many reasons why a Blood Pressure reading may have not been correct.   First, the individual taking the blood pressure did not know what they were doing and did not properly administer the test.  For example, the cuff may not have been properly placed upon the patient.  Second, the blood pressure machine was not accurate.  Third, the blood pressure read was improperly recorded by the test taker.  Fourth, the transcriber made an error in typing up the blood pressure number when generating the medical report.

What Should I Do If I Have a “White Coat Syndrome” High Blood Pressure?

It is recommended that you immediately consult with your family physician to test your blood pressure and assess whether you have a blood pressure condition.    Depending on the results, you may wish to consult a workers’ compensation attorney.

What If I Need Legal Advice?

If you would like a free consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years.

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