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White Coat Hypertension — EECC MCQ

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EasyHypertension & Preventive CardiologyWhite Coat HypertensionEECC

A 45-year-old man has consistently elevated office BP readings (155/95 mmHg on three occasions). His GP arranges ambulatory blood pressure monitoring (ABPM). The 24-hour average is 128/80 mmHg and the daytime average is 132/82 mmHg. What is the correct interpretation?

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Correct answer: B — White coat hypertension — office BP is elevated but ambulatory BP is below the diagnostic threshold for hypertension

The 2024 ESC Hypertension Guidelines define hypertension by ABPM thresholds: 24-hour average ≥130/80 mmHg, daytime ≥135/85 mmHg, or night-time ≥120/70 mmHg. This patient's ABPM values (128/80 and 132/82 mmHg) are below these thresholds despite elevated office readings, confirming white coat hypertension (WCH). WCH affects approximately 15-30% of patients with elevated office BP. While WCH has a lower cardiovascular risk than sustained hypertension, it is not entirely benign — longitudinal studies show WCH patients have an intermediate risk between normotension and sustained hypertension. Annual ABPM monitoring and lifestyle modification are recommended.

Reference: ESC (2024): Guidelines for the Management of Elevated Blood Pressure and Hypertension