White coat hypertension vs. masked hypertension

White coat hypertension and masked hypertension are both conditions where blood pressure measurements deviate from the norm under certain circumstances. Here’s how they differ:

White Coat Hypertension:

Definition: White coat hypertension, also known as white coat syndrome, refers to elevated blood pressure readings that occur in a clinical setting (such as a doctor’s office or hospital) but are normal when measured outside of this environment.
Cause: It is believed to be due to the anxiety or stress associated with medical settings, leading to temporary increases in blood pressure.
Diagnosis: Diagnosis is typically made through ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM), which involves monitoring blood pressure over a 24-hour period or at home, respectively. If blood pressure readings are consistently elevated in a clinical setting but normal outside of it, white coat hypertension is diagnosed.
Risk: While white coat hypertension itself is not associated with increased cardiovascular risk, it may indicate an increased risk of developing sustained hypertension over time if left untreated.
Masked Hypertension:

Definition: Masked hypertension is the opposite of white coat hypertension. In this condition, blood pressure readings are normal in a clinical setting but elevated outside of it, such as at home or during daily activities.
Cause: The underlying mechanisms behind masked hypertension are not fully understood, but it may be related to stressors encountered in daily life or variations in blood pressure regulation throughout the day.
Diagnosis: Like white coat hypertension, diagnosis is typically made through ABPM or HBPM. If blood pressure readings are consistently normal in a clinical setting but elevated outside of it, masked hypertension is diagnosed.
Risk: Masked hypertension is associated with an increased risk of cardiovascular events, similar to sustained hypertension. Because blood pressure measurements taken in clinical settings may underestimate the true risk, identifying masked hypertension is important for appropriate management and risk reduction.
In summary, white coat hypertension involves elevated blood pressure readings in clinical settings but normal readings outside of them, whereas masked hypertension involves normal readings in clinical settings but elevated readings outside of them. Both conditions highlight the importance of ambulatory or home blood pressure monitoring to accurately assess blood pressure and identify individuals at increased cardiovascular risk.

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