Special situations in the diagnosis and management of arterial hypertension: white-coat hypertension and masked hypertension
Abstract
White-coat hypertension is a common phenomenon. It is present in about one third of subjects with office hypertension, typically in females, at higher age and non-smokers.
Prognostic data are not enough reliable but some studies with long-term follow-up show that cardiovascular risk is increased when compared with normotensive subjects. The inverse phenomenon is masked hypertension.
Its prevalence in population-based studies is about 13%. It is more common in males, typically aged between 30 and 50 years, smokers with unfavourable risk profile, and in diabetics.
The risk of future cardiovascular events is close to sustained hypertension. It is underdiagnosed at present, and therefore, home blood pressure (BP) measurement should be recommended also to the subjects with normal office BP.
There are no prospective trials testing treatment of either white-coat hypertension or masked hypertension. Nonpharmacologic treatment is started in subjects with low cardiovascular risk while in high-risk patients, drug treatment should be considered.
This is, however, a purely empirical approach.