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White coat hypertension — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareWhite coat hypertensionUSMLE Step 3

A 49-year-old woman has repeated clinic blood pressures near 150/90 mm Hg, but validated home readings average 124/76 mm Hg. She has no diabetes, kidney disease, or cardiovascular disease. Urinalysis and basic metabolic panel are normal. Which of the following is the most likely explanation for this patient's findings?

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Reveal the answer and explanation

Correct answer: B — Transient office-related sympathetic blood pressure elevation

White coat hypertension is suggested by elevated office readings with normal validated out-of-office readings.

Reference: USPSTF A and B Recommendations, 2025-2026: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations