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White Coat Hypertension ABPM CKD — ESENeph MCQ

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ModerateHypertensionWhite Coat Hypertension ABPM CKDESENeph

A 68-year-old woman with CKD G3b (eGFR 38 mL/min/1.73m2) has BP readings of 148/88 mmHg in clinic but 126/78 mmHg on ambulatory blood pressure monitoring (ABPM). She is on amlodipine 5 mg daily. What does this pattern represent and what is the most appropriate action?

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Correct answer: D — White coat hypertension — do not intensify treatment, continue ABPM monitoring

Elevated clinic BP (≥140/90 mmHg) with normal ABPM (<130/80 mmHg daytime average) defines white coat hypertension (also called isolated clinic hypertension). In CKD, ABPM is the reference standard for BP assessment (KDIGO 2024). White coat hypertension should NOT be treated with additional antihypertensives as over-treatment risks hypotension, falls, and AKI. The appropriate management is continued ABPM monitoring (typically annually) as some patients progress to sustained hypertension. Masked hypertension is the opposite — normal clinic BP with elevated ambulatory BP — and does require treatment intensification.

Reference: KDIGO 2024 – CKD Guideline; NICE 2019 – NG136 Hypertension; UKKA 2019 – BP in CKD