I am 66 years old, 5ft, 3", medium build, weight 143 lbs, 31.5 inch waist. I ride a touring road bicycle 5 days a week, 20 miles, 100 minutes each ride. I also lift free-weights and dance.
I have had hypertension for 30 years and white coat syndrome for the past 10 years. During the past ten years I have taken my pressure and pulse at home using a digital machine. The accuracy of this machine has been verified by three doctors.
My medication has effectively done the job controlling the hypertension. However, during the past ten years when I am in a medical environment regardless of the type or situation my pressure is elevated. During the past ten years multiple doctors have all acknowledged my white coat syndrome and based treatment on my readings outside of medical environment.
Recently, I relocated to south Florida and have yet another primary care doctor. This doctor, however, refuses to acknowledge white coat syndrome and insists readings should be at the same level regardless of where and when they are taken.
Since my first physical with this doctor he has had me come into the office every month for the past four months. Each visit is a mirror image of the previous visit including listening to my heart and lungs. The nurse takes my pressure, pulse and weight. Typically, the pressure is 160/75. He sits in his chair looking at my medical record, makes notes and says very little.
His most recent decision was to have me take my pressure and pulse at home every day at various times for a month. I took pressure and pulse readings 88 times during the month. The overall averages were pressure: 109/59 and pulse: 43. My activities immediately preceding the readings represent 95% of my typical retired life style. After very briefly looking at the report I gave him he instructed me to change my medication from Atenolol, 50mg daily & Lotrel, 10/20mg daily to Atenolol, 50mg daily & Lotrel, 10/40mg daily. He also scheduled me for yet another follow-up visit in three weeks.
Here is what I think:
1. Do not change my medication. Continue to focus treatment on the majority and not the exception (white coat syndrome) which would typically occur a couple times a year.
2. Stop these redundant office visits and return to a schedule of an annual physical and one or two follow-up office visits per year.
3. Continue to monitor my pressure and pulse on a regular schedule at home.
What do you think?