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White coat hypertension effect — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareWhite coat hypertension effectUSMLE Step 3

A 49-year-old man with hypertension returns after home blood pressure monitoring. Office readings have been 150/92 and 148/90 mm Hg. Home readings averaged 128/76 mm Hg using a validated cuff. He takes amlodipine 5 mg daily and has no symptoms. Serum creatinine and urinalysis are normal. Which of the following is the most likely explanation for this patient's findings?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — White coat effect with adequate out-of-office control

Lower home readings with elevated clinic readings suggest a white coat effect. Management should incorporate validated out-of-office measurements before intensifying therapy.

Reference: ACC/AHA hypertension guideline