Understanding White Coat Hypertension and Masked Hypertension.

Dr. Zayed | Published: April 12, 2025.

White Coat Hypertension

White coat hypertension (WCH) is characterized by elevated blood pressure (BP) readings in a clinical setting, typically ranging from 130/89 mm Hg to 160/100 mmHg, with normal BP values (<130/80 mmHg) observed during ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM). This phenomenon is primarily driven by transient sympathetic nervous system activation secondary to anxiety or stress during medical encounters. Diagnosis requires multiple BP measurements per visit, conducted across at least two separate occasions, followed by confirmation with ABPM or HBPM after a 3-month period of lifestyle interventions, such as dietary optimization, increased physical activity, and stress management. Management focuses on sustained non-pharmacologic strategies, with annual ABPM or HBPM to monitor for progression to sustained hypertension, which occurs at a rate of approximately 1–5% per year. While the direct association between WCH and atherosclerotic cardiovascular disease (ASCVD) remains inconclusive, cardiovascular risk stratification should account for coexisting risk factors, including dyslipidemia, diabetes, or smoking.


Masked Hypertension

In comparison to WCH, Masked HTN has normotensive BP readings in clinical settings (<130/80 mmHg) contrasted with elevated BP values in out-of-office environments (home and work), as confirmed by ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM). This condition often remains undetected without targeted screening and is associated with a cardiovascular risk profile comparable to sustained hypertension. Screening with ABPM or HBPM is recommended for individuals with in-office systolic BP of 120–129 mmHg or diastolic BP of 75–79 mmHg. Upon diagnosis, management entails a combination of lifestyle modifications (e.g., weight reduction, dietary sodium restriction (DASH DIET), and regular exercise) and pharmacologic antihypertensive therapy tailored to the patient’s risk profile. Annual reassessment with ABPM or HBPM is advised to ensure sustained BP control. Masked Hypertension is "strongly correlated with increased risks of stroke, cardiovascular events, and all-cause mortality", underscoring the importance of early detection and intervention to mitigate adverse outcomes in comprehensive cardiovascular risk management.

REFERENCES:

A Review on Masked Hypertension

White Coat Hypertension Article

General Understanding of MH VS WCH.


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