A 55-year-old man has office blood pressure consistently 138/86 mmHg on three visits. His 24-hour ambulatory blood pressure monitoring shows daytime average 148/92 mmHg and nighttime average 134/82 mmHg. What is the most appropriate diagnosis?

• A White coat hypertension
• B Sustained hypertension
• C Sustained normotension
• D Masked hypertension ✓

Explanation

Masked hypertension is defined as normal office blood pressure but elevated out-of-office readings on ambulatory or home monitoring. The diagnostic thresholds on ambulatory blood pressure monitoring are daytime average ≥135/85 mmHg, nighttime ≥120/70 mmHg, or 24-hour average ≥130/80 mmHg. This patient's daytime average of 148/92 mmHg meets the criteria. White coat hypertension is the opposite pattern: elevated office but normal out-of-office pressures. Masked hypertension carries cardiovascular risk comparable to sustained hypertension.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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