My BP is normal at home, but high in the clinic. Why?

Q. My BP is normal at home, but high in the clinic. Why?

Answered by
Dr. Muhammad Zohaib Siddiq
and medically reviewed by Dr. K Shobana
This is a premium question & answer published on Sep 29, 2016 and last reviewed on: Jun 01, 2023

Hi doctor,

I have been regularly taking hypertension medicines Amlopin-M and Omnitan-H for a long time. My blood pressure was normal when measured at home with the help of an automatic BP monitor and a mercury sphygmomanometer by a doctor's assistant in my home. But, in the clinic, my doctor diagnosed me with a blood pressure of 190/110 mmHg. He changed my medicines and I have uploaded the same prescription for your reference. When I had the tablet Vinicor XL at 9 PM, I started having severe problems like excessive thirst, severe headache, sleeplessness and dizziness after 1 hour. When I consulted my doctor the next day, he told me to stop taking Vinicor XL. I had a better sleep next night, but still I feel like I have an overdose as I am feeling weaker, lightheaded and have tremors. My blood pressure readings at home have dropped lower than their usual values. The blood pressure readings at the hospital are still 160/100 mmHg. Please suggest the correct dosage of prescribed medicines.



Welcome to

You are taking antihypertensive medicines (attachment removed to protect patient identity). Blood pressure remains in control, but elevated in the doctor's clinic is called as white coat hypertension and it is due to the stress you may develop in clinic. You took LN-Bloc (Cilnidipine), Amlopin-M (Amlodipine and Metformin) and Vinicor (Metoprolol) and all of which are beta blockers. Taking two or more beta blockers may cause your heart to slow down and this seems to be the cause of your dizziness. Whenever some doctor prescribes a new medicine, always show them your previous record. You are obese, which is a risk factor for hypertension and also heart diseases and diabetes. Reduce your weight, do exercise and decrease salt intake. These measures will settle your blood pressure. Try to have good sleep and reduce your stress and anxiety. You did not tell your age and whether you are diabetic or not. Please tell me these details, so that further diagnosis and causes can be ruled out. If you are having diabetes, then control your sugar levels.

Investigations to be done:

Do renal function tests, ECG (electrocardiogram), echocardiography and urine routine test.

Regarding follow up:

Revert back with the reports to a cardiologist online.

Thank you doctor,

I am 48 years old and I am not diabetic.



Welcome back to

Good to know you do not have diabetes. I do not know for how long you are hypertensive, but if you developed high blood pressure before age 40, then secondary causes of hypertension should be ruled out. In that case, apart from investigations I suggested you earlier; renal Doppler ultrasound will be of great help. Your previous medicines are fine to control blood pressure. I suggest you to switch back to those medicines. Consult your doctor, discuss with him or her and take the medicine with consent. Remember, medicines are only a part of treatment of blood pressure and not the whole treatment. Controlling blood pressure needs more than only medicines. I suggest you some steps. Reduce your weight, so that your BMI becomes less than 25. Avoid stress. Yoga is good for this. Also, do regular exercise such as brisk walking for at least 30 minutes a day for at least 5 days a week. Decrease salt intake to less than 25 mg sodium per day. It equals to one teaspoon of salt per day. Also, avoid fatty foods, junk foods and fast foods. Take medicines regularly and barely at the same time each day. Blood pressure is a dynamic entityt; it keeps on changing from time to time, from condition to condition. So, checking blood pressure should not be done in a stressful environment. Home BP recordings better reflect real blood pressures than clinic blood pressures. I strongly recommend to buy BP apparatus at your home and check BP regularly. Check BP while sitting on a chair with back rest for 10 minutes. Keep arm at heart level with support on the table. Do not take caffeine or smoking for 2 hours. Be relaxed, remind some happy moment of your life for 10 minutes. Then, your blood pressure will reflect real BP. Take two BP readings with at least 30 minute interval. Check BP in both arms and the higher one is your blood pressure.

Thank you doctor,

Can I hold fast under these medications? But, I do will drink juice and eat fruits. Is it fine?



Welcome back to

As far as controlling high blood pressure is concerned, there is no need to fast. You can eat whatever you like if home cooked. Just avoid fast foods, junk foods, high salt and fatty foods. You can eat fruits, vegetables, pulses, rice, chicken, fish and sometimes mutton too. Regarding fasting as a religious action, you can fast. There is no harm. Regarding losing weight, there is no need to fast. Just do the exercise and avoid the foods mentioned above. The best exercises are brisk walk, jogging, cycling, swimming, playing sports, etc. Brisk walk means walking as fast as you can and not running.

Thank you doctor,

I wanted to hold fast as a religious action.



Welcome back to

Yes, you can fast and take medicines before fasting or after fasting. Do not miss medicines. Sometimes, taking medicines on an empty stomach causes stomach discomfort. If you had ever experienced such symptoms with these medicines, in that case you should not take medicines on an empty stomach. You can fast, there is no harm in that, but take medicines regularly.

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