Patients whose blood pressure only spikes at the doctor’s office are twice as likely to die of a heart attack or other cardiac event

For decades, doctors have been aware of a phenomenon known as “white coat hypertension” — when a patient gets higher blood pressure readings at the doctor’s office than they do at home, perhaps because they’re anxious in the clinic — but previous studies have shown inconsistencies in its effects.

Now, a large new meta-analysis confirms patients with the condition are more than twice as likely to die from a cardiac event as those whose blood pressure readings are always normal.

These same patients have a 33% increased mortality risk and are 36% more likely to experience a cardiac event like a heart attack, according to the study published Monday in Annals of Internal Medicine.

The analysis, which pulled data from for those events but has no known symptoms. They point, too, to the importance of accurate blood pressure monitoring that patients can take on their own, some researchers argued.