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Clinical Significance and Treatment Requirements in White Coat and Masked Hypertension

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Special Issues in Hypertension

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Abstract

White coat hypertension (WCHT) and masked hypertension (MH) are phenomena that were identified and detected once blood pressure (BP) measurements became possible outside an office setting. The threshold values generally used to diagnose WCHT are >140/90 mmHg in the office setting and <135/85 mmHg in an ambulatory or home setting. Subjects with MH have a normal office BP of <140/90 mmHg and an abnormal out-of-office BP ≥135/85 mmHg. The prevalence of WCHT and MH varies according to the definition of WCHT and MH and the population studied, but it is generally around 30 % for mild, sustained hypertensive (SH) subjects. Several measures of target organ damage have been compared for normotensive, WCHT, MH, and sustained hypertension subjects; these include left ventricular mass, microalbuminuria, and carotid intima-media atherosclerosis. In general, target organ damage in WCHT is less than that observed in MH or SH. Authors of prospective studies have concluded that WCHT subjects have a lower risk of morbidity than MH subjects. Recent meta-analyses confirm that the incidence cardiovascular (CV) events is more important in patients with MH, and that subjects with MH have the same CV risks that subjects with SH. When WCHT subjects are prescribed antihypertensive medications, there is usually a decrease in clinical BP, but little or no change in ABP. Thus, drug treatment is not necessarily indicated. For MH subjects, in the absence of a randomized trial, treatment recommendations might be premature but the existence of MH in a patient with CV risk or signs of CV damage must be an incentive to promote lifestyle changes and even to start pharmacological treatment. In any case, these patients should be followed closely over time.

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Authors and Affiliations

  1. Department of Internal Medicine and Cardiology, Joseph Fourier University, Grenoble, France

    Jean-Michel Mallion

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  1. Jean-Michel Mallion
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Correspondence to Jean-Michel Mallion .

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Editors and Affiliations

  1. , Internal Medicine, American University of Beirut Medical Ce, Riad El Solh, Beirut, 1107-2020, Lebanon

    Adel E. Berbari

  2. Clinica Medica, Ospedale S. Gerardo, Università di Milano-Bicocca, V .Donizetti 106, Milano, Monza, 20133, Italy

    Giuseppe Mancia

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Mallion, JM. (2012). Clinical Significance and Treatment Requirements in White Coat and Masked Hypertension. In: Berbari, A., Mancia, G. (eds) Special Issues in Hypertension. Springer, Milano. https://doi.org/10.1007/978-88-470-2601-8_2

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  • DOI: https://doi.org/10.1007/978-88-470-2601-8_2

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