Reasons to evaluate a patient for masked or white coat hypertension

Reason	Antihypertensive treatment status	Suspected classification
Office-based blood pressures 10 mmHg or less below the patient's goal (eg, systolic pressure 120 to 129 mmHg)	Not on treatment	Masked hypertension
Office-based blood pressures below the patient's goal plus any of the following: Elevated atherosclerotic cardiovascular disease risk (eg, 10-year atherosclerotic cardiovascular disease risk >10%) Chronic kidney disease Diabetes mellitus Evidence of new or worsening end-organ damage (eg, prior atherosclerotic cardiovascular event, heart failure, left ventricular hypertrophy, hypertensive retinopathy)	On treatment	Masked uncontrolled hypertension
Office-based blood pressures above the patient's goal (but <180/120 mmHg) despite a 3-month trial of lifestyle modifications, and no evidence of hypertensive end-organ damage	Not on treatment	White coat hypertension
Office-based blood pressures above the patient's goal	On a minimum of 3 medications	White coat effect
Office-based blood pressures at or above the patient's goal with symptoms of hypotension (eg, lightheadedness, falls) at home or work	On treatment	White coat effect
Labile office-based blood pressures	Not on treatment or on treatment	All of the above

Adapted from:

Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Hypertension 2018; 71:e13.
Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J 2018; 39:3021.
Nerenberg KA, Zarnke KB, Leung AA, et al. Hypertension Canada's 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children. Can J Cardiol 2018; 34:506.

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