A 38-year-old woman has office blood pressure recordings of 150/94 and 154/98 mmHg over three separate visits. Her 24-hour ambulatory monitoring shows a daytime average of 129/79 mmHg and a nighttime average of 116/68 mmHg. What is the correct diagnosis?
- A Sustained hypertension requiring drug therapy
- B Masked hypertension
- C White coat hypertension ✓
- D Secondary hypertension
Correct answer: C. White coat hypertension
Explanation
Out-of-office daytime averages below 135/85 mmHg rule out true sustained hypertension when office readings are elevated, defining white coat hypertension. Masked hypertension is the mirror image: normal office readings with elevated ambulatory averages above 135/85 during the day. These patients have normal out-of-office values on both counts and generally warrant lifestyle advice and periodic re-monitoring rather than immediate antihypertensive drug treatment.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.