Interpretation blood pressure readings white coat and masked hypertension (table).
Define white coat hypertension.
elevated blood pressure readings in a clinical setting (caused by anxiety) but normal readings when measured elsewhere
List diagnostics for white coat hypertension.
Confirm true elevation of the in-office blood pressure measurements.
Take different blood pressure measurements several minutes apart (after the patient has had time to relax).
Take blood pressure measurements on several visits (at least two).
Consider screening using daytime ABPM (preferable) or HBPM in patients with in-office blood pressure ≥ 130/89 mm Hg and ≤ 160/100 mm Hg after a 3-month trial of lifestyle changes.
Diagnosis is confirmed in patients with: [1]
In-office readings ≥ 130/89 mm Hg and ≤ 160/100 mm Hg
AND out-of-office readings < 130/80 mm Hg
Describe the management of white coat hypertension.
Continue lifestyle changes for managing hypertension.
Repeat ABPM or HBPM annually to monitor for progression to sustained hypertension.
Hypertension that is only recorded in clinical settings in patients currently on antihypertensive medication is called white coat effect.
Define masked hypertension.
normal blood pressure readings in a clinical setting but consistently elevated readings when measured elsewhere
Describe the screening and management of masked hypertension.
Screening: Consider ABPM or HBPM in adults with consistent in-office SBP 120–129 mm Hg or DBP 75–79 mm Hg. [8]
Management
Start pharmacological treatment of hypertension.
Repeat ABPM or HBPM annually.
Patients with masked hypertension have a similar risk of stroke, cardiovascular disease, and all-cause mortality to those with sustained hypertension
Define isolated systolic hypertension.
: elevated SBP (≥ 140 mm Hg) with DBP within normal limits (≤ 90 mm Hg)
List causes of isolated systolic hypertension.
Most common: decreased arterial elasticity and compliance due to aging
May also be secondary to increased cardiac output due to:
Anemia
Hyperthyroidism
Chronic aortic regurgitation
AV fistula
List clinical features of isolated systolic hypertension.
Often asymptomatic
Signs of increased pulse pressure: e.g., head pounding, rhythmic nodding, bobbing of the head in synchrony with the heartbeat
Symptoms of hypertension
Describe the diagnostics and treatment of isolated systolic hypertension.
Diagnostics
Assess for secondary causes.
See “Diagnosis of hypertension” for details on diagnostic testing.
Treatment
Recommend lifestyle changes for managing hypertension.
First-line medication: thiazide diuretics or dihydropyridine calcium antagonists [18]
Treatment goal: SBP < 140 mm Hg
Patients with isolated systolic hypertension have a high risk of renal dysfunction and cardiovascular events, e.g., myocardial infarction, stroke.
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