White coat hypertension (WCH) can be a challenge to accurately diagnose and to manage effectively.


Synonyms: office hypertension, clinic hypertension


Criteria for white coat hypertension:

(1) The patient has blood pressure readings that are hypertension when in a medical setting.

(2) The patient is normotensive at other times.

(3) These changes are documented on multiple occasions (which minimizes the chance of a random error).


This is a heterogenous group of patients:

(1) Some patients are hypertensive and the "normal" blood pressure readings are in error.

(2) Some patients are normotensive but become anxious in a medical setting.

(3) Some patients are normotensive but the blood pressure readings in the medical setting have been taken when the patient has undergone recent exertion.

(4) The person is evolving into hypertension.



(1) A person who is normotensive outside of a medical setting may not need drug therapy but may benefit from lifestyle changes such as exercise and weight loss.

(2) It is important not to assume that the condition is benign. The patient needs to be followed so that any progression can be detected and treated appropriately.

(3) Particular care is required for patients with diabetes or with features of the metabolic syndrome.


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