White coat hypertension vs. masked hypertension

White coat hypertension and masked hypertension are both conditions in which blood pressure measurements differ from the typical readings taken in clinical settings, but they manifest in different situations.

  1. White Coat Hypertension:
    • Definition: White coat hypertension refers to elevated blood pressure readings that occur in a medical setting, such as a doctor’s office or clinic, but are not present outside of this setting.
    • Characteristics: Patients with white coat hypertension may experience anxiety or stress in clinical settings, leading to temporarily elevated blood pressure readings. However, their blood pressure is typically normal when measured in non-medical settings, such as at home or during daily activities.
    • Diagnosis: Diagnosis of white coat hypertension is made based on elevated blood pressure readings in clinical settings despite normal readings outside of these settings. Ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring may be used to confirm the diagnosis.
    • Clinical Implications: While white coat hypertension may not carry the same cardiovascular risk as sustained hypertension, it still warrants monitoring and lifestyle interventions to prevent the development of true hypertension and associated complications.
  2. Masked Hypertension:
    • Definition: Masked hypertension refers to normal blood pressure readings in clinical settings, but elevated readings outside of these settings, such as at home or during daily activities.
    • Characteristics: Patients with masked hypertension may have consistently normal blood pressure measurements during office visits, leading to a false sense of security. However, their blood pressure is actually elevated at other times, increasing their risk of cardiovascular complications.
    • Diagnosis: Diagnosis of masked hypertension relies on the identification of elevated blood pressure readings outside of clinical settings through ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring. These methods provide a more comprehensive assessment of blood pressure patterns over a 24-hour period.
    • Clinical Implications: Masked hypertension is associated with an increased risk of cardiovascular events, similar to sustained hypertension. Therefore, early detection and appropriate management, including lifestyle modifications and, if necessary, pharmacological treatment, are important to reduce the risk of complications.

In summary, while both white coat hypertension and masked hypertension involve discrepancies between blood pressure measurements in clinical settings and other settings, they represent different patterns of blood pressure variability and have distinct clinical implications. Identification and appropriate management of these conditions are important for optimizing cardiovascular health and reducing the risk of associated complications.

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