False Versus True Resistant Hypertension

  • Gianfranco Parati
  • Juan E. Ochoa
  • Grzegorz Bilo


Current guidelines for the management of resistant hypertension define resistance to antihypertensive treatment based on office blood pressure measurements. However, given the acknowledged limitations of office blood pressure in assessing blood pressure control, a first step in the diagnostic approach of the patient with resistant hypertension consists in defining whether resistance to antihypertensive treatment is true or whether the persisting blood pressure elevation is just the result of an emotional reaction to the doctor’s visit, known as the “white-coat effect,” still evident during treatment, thus corresponding to a “false resistance” phenomenon when coupling office readings with out-of-office BP measuring techniques. Indeed, when combining office BP readings either with ambulatory or with home blood pressure monitoring, a treated patient initially identified as having resistant hypertension based on office blood pressure values may fall into one of four categories: (1) true BP control (normal in-office and out-of-office blood pressure levels); (2) true resistant hypertension (elevated in-office and out-of-office blood pressure levels); (3) false or “white-coat” resistant/uncontrolled hypertension (elevated in-office but normal out-of-office blood pressure levels); and (4) false BP control or masked resistant/uncontrolled hypertension (normal in-office but elevated out-of-office blood pressure levels). A proper assessment of blood pressure control and classification of treated hypertensive patients with the combined use of office, ambulatory, and ideally home blood pressure measurements are of upmost relevance for defining the need for performing additional diagnostic procedures (i.e., screening tests for secondary causes of resistant hypertension) and/or implementing more aggressive pharmacological or interventional strategies for the management of resistant hypertension.


Antihypertensive treatment  Blood pressure control  24-h ambulatory BP monitoring  Home BP monitoring  Office blood pressure  Resistant hypertension  True resistant hypertension  False resistant hypertension  True BP control  False BP control  “white-coat” effect  Cardiovascular risk  Treatment adherence  


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Copyright information

© Springer-Verlag Italia 2013

Authors and Affiliations

  • Gianfranco Parati
    • 1
  • Juan E. Ochoa
    • 1
  • Grzegorz Bilo
    • 2
  1. 1.Department of Health Sciences, and Department of Cardiology University of Milano-Bicocca and S. Luca Hospital, IRCCS Istituto Auxologico ItalianoMilanItaly
  2. 2. Department of Cardiology S. Luca Hospital, IRCCS Istituto Auxologico ItalianoMilanItaly

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