What is the difference between white coat hypertension and masked hypertension?

White coat hypertension is the opposite of masked hypertension: blood pressure is elevated in clinic (above 130/80) but normal on home or ambulatory monitoring, affecting approximately 15–30% of men with apparent clinic hypertension, while masked hypertension has normal clinic readings with elevated home/ambulatory readings, affecting 15–20% of men told their blood pressure is normal; the gold standard to distinguish both is 24-hour ambulatory blood pressure monitoring (ABPM) (Pickering et al., Hypertension, 2005).

Both conditions require ABPM to accurately characterize. Treating white coat hypertension with medications based only on clinic readings may overtreat a man who has no sustained cardiovascular risk from blood pressure. Leaving masked hypertension untreated because clinic readings are "fine" fails a man with genuine cardiovascular risk. The clinical message: a single clinic blood pressure measurement, even done carefully, is insufficient to make treatment decisions for men in the borderline zone (120–140 mmHg systolic).

Honesty Scale: Solid (1) for white coat and masked hypertension as distinct clinical entities distinguishable by ABPM.

What to do: If you are being considered for antihypertensive medication based on clinic readings, request a 24-hour ABPM before starting therapy. If you have been told you are "borderline" for blood pressure, the same applies. Medicare and most private insurance cover ABPM when ordered for blood pressure classification purposes.

For the full picture, read The Blood Pressure Deep Dive