White Coat Hypertension Management — EECC MCQ

Correct answer: B — White coat hypertension does NOT require antihypertensive treatment — however, these patients have a small increased CV risk compared with truly normotensive individuals and should have annual ABPM/HBPM to detect progression to sustained hypertension, with lifestyle modification advised

White coat hypertension (WCH, 'isolated office hypertension'): elevated office BP (≥140/90) with normal out-of-office BP (<135/85 HBPM or <130/80 24h ABPM). The 2024 ESC Hypertension Guidelines: (1) DO NOT initiate antihypertensive medication for WCH (Class III); (2) risk is NOT zero — meta-analyses show WCH carries a small but real increased CV risk compared with true normotension (possibly from intermittent BP elevations, progression to sustained HTN, or metabolic risk clustering); (3) annual out-of-office BP monitoring is recommended (WCH progresses to sustained HTN in 15-30% over 5 years); (4) lifestyle modification advised (weight management, exercise, sodium reduction, moderate alcohol); (5) if target organ damage is present (LVH, microalbuminuria, arterial stiffness), treatment should be considered despite normal ABPM — this represents masked uncontrolled hypertension. The reciprocal phenotype — masked hypertension (normal office, elevated ABPM) — DOES require treatment.

Reference: ESC (2024): Hypertension Guidelines