White-Coat Hypertension and Masked Hypertension

White-coat hypertension and masked hypertension are conditions in which a patient’s blood pressure readings are inaccurate due to certain environments.

Patients with white-coat hypertension experience a spike in their blood pressure specifically when it is measured at the doctor’s office but not in other settings, such as the home.

Patients with masked hypertension, on the other hand, have normal blood pressure readings at the doctor’s office but the experience increases in blood pressure at other times of day or in different settings.

Symptoms

The main symptom for both of these conditions is unreliable blood pressure readings in the doctor’s office.

Causes and Risk Factors

General risk factors for hypertension include age, obesity, tobacco use, little or no physical activity, stress, heavy alcohol use and poor diet. African-American men and patients with certain chronic conditions such as diabetes and kidney disease are also at increased risk of developing hypertension and masked hypertension.

Patients experiencing anxiety or stress over their doctor’s appointment may be at increased risk of developing white-coat hypertension.  

Diagnosis

Patients with white-coat or masked hypertension often require special monitoring and testing to ensure they receive the most accurate diagnosis. Patients with these conditions may be misdiagnosed if only standard in-office testing is used.

Ambulatory blood pressure monitoring allows the patient’s physician to assess the patient’s blood pressure over an extended period of time outside the doctor’s office. This method provides overall blood pressure levels and offers a more complete picture of the patient’s condition, to ensure appropriate treatment and control of elevated blood pressure.

Treatments

Lifestyle changes and medication often are used in combination to treat a patient’s hypertension.

The most commonly used medications are Angiotensin-Converting Enzyme (ACE) inhibitors, Angiotensin II Receptor Blockers (ARBs) and calcium channel blockers. Diuretics and adrenergic blockers can also be helpful in controlling blood pressure.

Some patients may have resistant hypertension, in which blood pressure may remain elevated despite the use of three or more different medications. This condition requires careful evaluation by the physician, as these patients may be at increased risk of heart attack or stroke.

In the most difficult cases of resistant hypertension, the condition may be a result of underlying factors, including hyperaldosteronism. In such cases, an interdisciplinary approach, such as the one employed by the Hypertension Center in the Cedars-Sinai Heart Institute, is vital for establishing an accurate diagnosis and initiating effective treatment.

Patients with accurately diagnosed white-coat hypertension who do not have consistently high blood pressure at any other time may not need treatment with medications. However, patients with this condition should be monitored by their physician, as they may be at an increased risk of developing hypertension in the future.