Prevalence of white-coat and masked hypertension in national and international registries

Gorostidi, Manuel; Vinyoles, Ernest; Banegas, José R; de la Sierra, Alejandro

doi:10.1038/hr.2014.149

Cited by 141Blood Pressure and Hypertension StudiesCardiovascular Health and Disease PreventionSodium Intake and Health

Prevalence of white-coat and masked hypertension in national and international registries

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Gorostidi, Manuel, Vinyoles, Ernest, Banegas, José R, de la Sierra, Alejandro·2015·Hypertension Research

DOI 10.1038/hr.2014.149

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Abstract

In the past two decades, techniques for the measurement of blood pressure outside the medical setting have unmasked highly prevalent situations. A significant proportion of patients with office blood pressure levels above the thresholds for diagnosing hypertension or above the limits where those being treated are considered to be adequately controlled actually show normal ambulatory blood pressure levels. These patients have white-coat hypertension if untreated or false resistance to antihypertensive therapy because of the white-coat effect if treated. However, some individuals with normal office blood pressure measurements show elevated ambulatory blood pressure levels, and thus have masked hypertension if untreated or masked uncontrolled hypertension if treated. When looking for white-coat hypertension in patients with elevated office blood pressure levels or when looking for masked hypertension in office-controlled patients, up to one in three patients in each scenario would have white-coat or masked hypertension. Although related clinical factors, such as age, gender and global cardiovascular risk, are associated with both conditions, their abilities to predict such a misclassification are very low. Thus, assessing individual blood pressure levels by means of an ambulatory technique, particularly ambulatory blood pressure monitoring, is now considered a priority in diagnosing hypertension and in evaluating hypertension control.

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Office BP is consistently least predictive of cardiovascular outcomes among BP measurement methods due to white-coat and masked effects.
“Although office BP was the most commonly used method by the included RCTs and in clinical practice, it is consistently least predictive of cardiovascular outcomes among BP measurement methods due to both white-coat and masked effects 51,52”
From Effect and Acceptability of Mindfulness-Based Stress Reduction Program on Patients With Elevated Blood Pressure or Hypertension: A Meta-Analysis of Randomized Controlled Trials (2020) · cites this paper as [51]
The Introduction says office BP is a momentary measure affected by the clinical setting and that ambulatory monitoring estimates true BP more accurately. The Misclassification section identifies white-coat and masked hypertension as reasons office and ambulatory assessments disagree. The paper does not establish that office BP is consistently the least predictive method for cardiovascular outcomes. (LLM, conf=0.85)
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Llisterri JL, Alonso FJ, Gorostidi M, Sierra C, de la Sierra A, Banegas JR, Segura J, Sobrino J, de la Cruz JJ, Madruga F, Aranda P, Redon J, Ruilope LM. En representación de los investigadores del Proyecto CARDIORISC-MAPAPRES. Sociedad Española de Hipertensión-Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA) Differences between office and ambulatory control of hypertension in very elderly patients. The CARDIORISC -MAPAPRES project. Med Clin (Barc) 2009; 133: 769-776.

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Barriers to accurate blood pressure measurement in the medical office
Hwang, K. O., Aigbe, A., Ju, H.-H., Jackson, V. C., & Sedlock, E. W. (2018) · Journal of Primary Care & Community Health · doi:10.1177/2150132718816929 · Cited by 53 · see citing works
“An estimated 10% to 50% of patients with high office BP readings have normal BP outside the office.(17) Improper measurement technique leading to falsely elevated BP measurements can lead to unnecessary initiation or escalation of BP medications with their attendant adverse effects and added costs.”
Background
Short-term trends in the prevalence, awareness, treatment, and control of arterial hypertension in Peru
Villarreal‐Zegarra, D., Carrillo-Larco, R. M., & Bernabé‐Ortiz, A. (2020) · Journal of Human Hypertension · doi:10.1038/s41371-020-0361-1 · Cited by 53 · see citing works
Prevalence and clinical characteristics of white-coat hypertension based on different definition criteria in untreated and treated patients
de la Sierra, A., Vinyoles, E., Banegas, J., Segura, J., Gorostidi, M., de la Cruz, J. D., & Ruilope, L. (2017) · Journal of Hypertension · doi:10.1097/hjh.0000000000001493 · Cited by 54 · see citing works
Self-citation
Prevalence of white coat and masked hypertension in Africa: A systematic review and meta‐analysis
Noubiap, J. J., Nansseu, J. R., Nkeck, J. R., Nyaga, U. F., & Bigna, J. J. (2018) · Journal of Clinical Hypertension · doi:10.1111/jch.13321 · Cited by 46 · see citing works
Ambulatory blood pressure monitoring in daily clinical practice – the Spanish ABPM Registry experience
Gorostidi, M., Banegas, J. R., de la Sierra, A., Vinyoles, E., Segura, J., & Ruilope, L. M. (2015) · European Journal of Clinical Investigation · doi:10.1111/eci.12565 · Cited by 44 · see citing works
Self-citation
Documento de la Sociedad Española de Hipertensión-Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA) sobre las guías ACC/AHA 2017 de hipertensión arterial
Gijón‐Conde, T., Gorostidi, M., Camafort, M., Abad-Cardiel, M., Martín-Rioboó, E., Morales‐Olivas, F. J., Vinyoles, E., Armario, P., Banegas, J. R., Coca, A., et al. (2018) · Hipertensión y Riesgo Vascular · doi:10.1016/j.hipert.2018.04.001 · Cited by 46 · see citing works
Self-citation
RSSDI Guidelines for the management of hypertension in patients with diabetes mellitus
Kumar, V., Agarwal, S., Saboo, B., & Makkar, B. M. (2022) · International Journal of Diabetes in Developing Countries · doi:10.1007/s13410-022-01143-7 · Cited by 45 · see citing works
“Patients with office BP values at least 20/10 mmHg higher when compared with their ambulatory values are positive for white coat hypertension [21].”
BackgroundInfluential
Documento de la Sociedad Española de Hipertensión-Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA) sobre monitorización ambulatoria de la presión arterial (MAPA) 2019
Gijón‐Conde, T., Gorostidi, M., Banegas, J. R., de la Sierra, A., Segura, J., Vinyoles, E., Divisón, J. A., & Ruilope, L. M. (2019) · Hipertensión y Riesgo Vascular · doi:10.1016/j.hipert.2019.05.002 · Cited by 41 · see citing works
Self-citation
A retrospective analysis of factors affecting surgical site infection in orthopaedic patients
Yang, J., Zhang, X., & Liang, W. (2020) · Journal of International Medical Research · doi:10.1177/0300060520907776 · Cited by 39 · see citing works
“Hypertension is common and its prevalence is rising in China as well as in other countries.(35,36) In an earlier study, hypertension was not found to be associated with increased SSI after posterior lumbar surgery(16) or only weakly associated with SSI in spinal surgery,(37) suggesting that the effect of hypertension…”
Background
Prevalence of Pediatric Masked Hypertension and Risk of Subclinical Cardiovascular Outcomes: A Systematic Review and Meta-Analysis
Chung, J., Robinson, C., Sheffield, L., Paramanathan, P., Yu, A., Ewusie, J. E., Sanger, S., Mitsnefes, M. M., Parekh, R. S., Sinha, M. D., et al. (2023) · Hypertension · doi:10.1161/hypertensionaha.123.20967 · Cited by 34 · see citing works
Comparison between the world health organization (WHO) and international society of hypertension (ISH) guidelines for hypertension
Nugroho, P., Andrew, H., Kohar, K., Noor, C. A., & Sutranto, A. L. (2022) · Annals medicus · doi:10.1080/07853890.2022.2044510 · Cited by 35 · see citing works
“overtreatment and undertreatment, respectively [15].”
Masked hypertension and its associated cardiovascular risk in young individuals: the African-PREDICT study
Thompson, J. E. S., Smith, W. T., Ware, L. J., Mels, C. M. C., van Rooyen, J. M., Huisman, H. W., Malan, L., Malan, N. T., Lammertyn, L., & Schutte, A. E. (2015) · Hypertension Research · doi:10.1038/hr.2015.123 · Cited by 31 · see citing works
Prediction of Masked Hypertension and Masked Uncontrolled Hypertension Using Machine Learning
Hung, M.-H., Shih, L.-C., Wang, Y.-C., Leu, H., Huang, P.-H., Wu, T., Lin, S.-J., Pan, W., Chen, J.-W., & Huang, C.-C. (2021) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2021.778306 · Cited by 33 · see citing works
“International registries show that MH/MUCH is a highly prevalent condition, present in up to one in three oﬃce-controlled patients (8).”
Background
Health Care Expenditures and Use Associated with Hypertension Among U.S. Adults
Wang, Y., Lee, J. S., Pollack, L. M., Kumar, A., Honeycutt, S., & Luo, F. (2024) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2024.07.005 · Cited by 30 · see citing works
National, regional and provincial prevalence of childhood hypertension in China in 2020: a systematic review and modelling study
Zhou, J., Wu, J., Jiang, D., Cai, S., Zhang, C., Ying, J., Cao, J., Song, Y., & Song, P. (2024) · The Lancet Child & Adolescent Health · doi:10.1016/s2352-4642(24)00260-8 · Cited by 28 · see citing works
Effect of bedtime administration of blood-pressure lowering agents on ambulatory blood pressure monitoring results: A meta-analysis
Sun, Y., Yu, X., Liu, J., Zhou, N., Chen, L., Zhao, Y., Li, X., Wang, J., & Cui, L. (2016) · Cardiology Journal · doi:10.5603/cj.a2016.0027 · Cited by 25 · see citing works
Measuring and managing blood pressure in a primary care setting: a pragmatic implementation study
Doane, J., Buu, J., Penrod, M. J., Bischoff, M., Conroy, M. B., & Stults, B. (2018) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2018.03.170450 · Cited by 23 · see citing works
“About one third of our patients with elevated clinic BP had white-coat hypertension in untreated patients or white-coat BP elevation in previously treated patients, similar to the 15% to 30% prevalence of white-coat hypertension in untreated patients and 25% to 38% prevalence of white-coat BP elevation in treated pati…”
Result
Ambulatory blood pressure in hypertensive patients with inclusion criteria for the SPRINT trial
de la Sierra, A., Banegas, J. R., Divisón, J. A., Gorostidi, M., Vinyoles, E., de la Cruz, J. J., Segura, J., & Ruilope, L. M. (2016) · Journal of the American Society of Hypertension · doi:10.1016/j.jash.2016.10.013 · Cited by 23 · see citing works
Self-citation
The dawning of the digital era in the management of hypertension
Matsuoka, R., Akazawa, H., Kodera, S., & Komuro, I. (2020) · Hypertension Research · doi:10.1038/s41440-020-0506-1 · Cited by 23 · see citing works
Diagnosing Hypertension in Primary Care Clinics According to Current Guidelines
Woolsey, S., Brown, B. A., Ralls, B., Friedrichs, M. D., & Stults, B. M. (2017) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2017.02.160111 · Cited by 22 · see citing works
“Discussion The 2015 USPSTF Recommendations for Screening for High BP in Adults(6) and other recent international guidelines aim to improve the accuracy of hypertension diagnosis (1) by using correct OBPM technique to avoid the frequent overestimation and occasional underestimation of office BP resulting from incorrect…”
BackgroundInfluential
Preference of blood pressure measurement methods by primary care doctors in Hong Kong: a cross-sectional survey
Lee, E. K. P., Choi, R. C. M., Liu, L., Gao, T., Yip, B. H. K., & Wong, S. Y. S. (2020) · BMC Family Practice · doi:10.1186/s12875-020-01153-6 · Cited by 22 · see citing works
Relationship Between Outpatient Clinic and Ambulatory Blood Pressure Measurements and Mortality
Aung, K., & Htay, T. (2019) · Current Cardiology Reports · doi:10.1007/s11886-019-1114-z · Cited by 22 · see citing works
Nighttime Blood Pressure Patterns and Subclinical Atherosclerosis in Women with Systemic Lupus Erythematosus
Sabio, J. M., Martínez-Bordonado, J., Sánchez‐Berná, I., Vargas‐Hitos, J. A., Mediavilla, J. D., Navarrete‐Navarrete, N., Zamora‐Pasadas, M., Ruíz, M. E., & Jiménez-Alonso, J. F. (2015) · The Journal of Rheumatology · doi:10.3899/jrheum.150531 · Cited by 21 · see citing works
Non-Invasive Continuous Blood-Pressure Monitoring Models Based on Photoplethysmography and Electrocardiography
Wu, H., Ji, Z., & Li, M. (2019) · Sensors · doi:10.3390/s19245543 · Cited by 21 · see citing works
“The intermittent blood-pressure measurements vary widely and cannot reflect an individual’s true blood pressure accurately, such as the “white-coat hypertension” and “masked hypertension” [5].”
Background
Temporary hypertension and white coat hypertension in the first trimester as risk factors for preeclampsia
Ohkuchi, A., Hirashima, C., Arai, R., Takahashi, K., Suzuki, H., Ogoyama, M., Nagayama, S., Takahashi, H., Baba, Y., Usui, R., et al. (2019) · Hypertension Research · doi:10.1038/s41440-019-0307-6 · Cited by 20 · see citing works
Prevalence trends of hypertension among 9–17 aged children and adolescents in Yunnan, 2017–2019: a serial cross-sectional surveillance survey
Yang, Y., Min, J., Chang, L., Chai, J., Song, Z., Zha, S., Zhang, M., Liu, H., & Yang, F. (2021) · BMC Public Health · doi:10.1186/s12889-021-10258-1 · Cited by 20 · see citing works
“This small decrease might be explained by the “whitecoat” effects [25, 26], or anxiety that could lead to the increased BP levels.”
Background
Sex Differences in Ambulatory Blood Pressure Levels and Subtypes in a Large Italian Community Cohort
Omboni, S., Khan, N. A., Kunadian, V., Olszanecka, A., Schutte, A. E., & Mihailidou, A. S. (2023) · Hypertension · doi:10.1161/hypertensionaha.122.20589 · Cited by 19 · see citing works
Effect of hospitalization on gastrointestinal motility and pH in dogs
Warrit, K., Boscan, P. L., Ferguson, L. E., Bradley, A., Dowers, K. L., & Twedt, D. C. (2017) · Journal of the American Veterinary Medical Association · doi:10.2460/javma.251.1.65 · Cited by 19 · see citing works
Remote Patient Monitoring Is Associated with Improved Outcomes in Hypertension: A Large, Retrospective, Cohort Analysis
Smith, W., Colbert, B., Namouz, T., Caven, D., Ewing, J. A., & Albano, A. W. (2024) · Healthcare · doi:10.3390/healthcare12161583 · Cited by 18 · see citing works
“However, this method may be affected by “White Coat Syndrome” and “Masked Uncontrolled HTN”, where office measurements may not accurately reflect the patient’s average blood pressure in a home or ambulatory setting [6].”
Method
White-coat and masked hypertension are associated with albuminuria in a general population: the Hisayama Study
Hata, J., Fukuhara, M., Sakata, S., Arima, H., Hirakawa, Y., Yonemoto, K., Mukai, N., Kitazono, T., Kiyohara, Y., & Ninomiya, T. (2017) · Hypertension Research · doi:10.1038/hr.2017.74 · Cited by 18 · see citing works
The prognostic value of blood pressure control delay in newly diagnosed hypertensive patients
Martín-Fernández, M., Vinyoles, E., Real, J., Soldevila, N., Muñoz, M. Á., García, J. L. D. V., Verdú-Rotellar, J. M., Domingo, M., & Mundet, X. (2018) · Journal of Hypertension · doi:10.1097/hjh.0000000000001896 · Cited by 18 · see citing works
Self-citation
Hypertension Prevalence Based on Three Separate Visits and Its Association With Obesity Among Chinese Children and Adolescents
Zhang, Q., Yang, L., Zhang, Y., Zhao, M., Liang, Y., & Xi, B. (2019) · Frontiers in Pediatrics · doi:10.3389/fped.2019.00307 · Cited by 18 · see citing works
“This trend might be explained by the “white-coat” effects (17, 18), or anxiety (19) that can result in increased BP levels.”
Background
Recomendaciones preventivas cardiovasculares. Actualización PAPPS 2022
Orozco‐Beltrán, D., Cuixart, C. B., Banegas, J. R., Gil-Guillén, V. F., Cuenca, A. M. C., Rioboó, E. M., Baldó, A. J., Vicuña, J., & Pérez, J. N. (2022) · Atención Primaria · doi:10.1016/j.aprim.2022.102444 · Cited by 21 · see citing works
Self-citation
Relationship Between Type of Hypertension and Renal Arteriolosclerosis in Chronic Glomerular Disease
Kono, K., Fujii, H., Nakai, K., Goto, S., Watanabe, S., Watanabe, K., & Nishi, S. (2016) · Kidney & Blood Pressure Research · doi:10.1159/000443440 · Cited by 17 · see citing works
Short-term variability and nocturnal decline in ambulatory blood pressure in normotension, white-coat hypertension, masked hypertension and sustained hypertension: a population-based study of older individuals in Spain
Gijón‐Conde, T., Graciani, A., López‐García, E., Guallar‐Castillón, P., García‐Esquinas, E., Rodríguez‐Artalejo, F., & Banegas, J. R. (2017) · Hypertension Research · doi:10.1038/hr.2017.9 · Cited by 16 · see citing works
Self-citation
Prevalence of Masked Hypertension: a Population-Based Survey in a Large City by Using 24-Hour Ambulatory Blood Pressure Monitoring
Rhee, M., Kim, S.-W., Choi, E. H., Kim, J., Nah, D.-Y., Shin, S., & Gu, N. (2016) · Korean Circulation Journal · doi:10.4070/kcj.2016.46.5.681 · Cited by 16 · see citing works
The Association of Health Literacy with High-Quality Home Blood Pressure Monitoring for Hypertensive Patients in Outpatient Settings
Fu, S., Dao, M.-C., Wong, C., & Cheung, B. (2020) · International Journal of Hypertension · doi:10.1155/2020/7502468 · Cited by 14 · see citing works
“Background Among hypertensive patients, 10% to 50% of their office blood pressure (BP) readings are higher than the home blood pressure readings [1].”
Background
Comparison Between Automated Office Blood Pressure Measurements and Manual Office Blood Pressure Measurements—Implications in Individual Patients: a Systematic Review and Meta-analysis
Bo, Y., Kwok, K. O., Chu, K. K.-Y., Leung, E. Y.-H., Yu, C. P., Wong, S. Y. S., & Lee, E. K. P. (2021) · Current Hypertension Reports · doi:10.1007/s11906-020-01118-1 · Cited by 15 · see citing works
“Clinically, manual office BP (MOBP) measurements involve BP measurements performed by doctors or clinical staff using a mercury, aneroid, or electronic oscillometric sphygmomanometer and are prone to both white-coat and masked effects [9].”
Method
Unattended automated office blood pressure measurement: Time efficiency and barriers to implementation/utilization
Doane, J., Flynn, M. C., Archibald, M., Ramírez, D. D. L. A., Conroy, M. B., & Stults, B. M. (2020) · Journal of Clinical Hypertension · doi:10.1111/jch.13840 · Cited by 14 · see citing works
Short-Term RCT of Increased Dietary Potassium from Potato or Potassium Gluconate: Effect on Blood Pressure, Microcirculation, and Potassium and Sodium Retention in Pre-Hypertensive-to-Hypertensive Adults
Stone, M. S., Martin, B., & Weaver, C. (2021) · Nutrients · doi:10.3390/nu13051610 · Cited by 11 · see citing works
“End-of-treatment BP comparisons were selected as the primary outcome measure because of errors associated with high screening and baseline BP, attributed to white coat syndrome, or similar participant unsettling due to unfamiliar circumstances on initial BP measurements [37].”
Background
Accuracy of screening strategies for masked hypertension: a large-scale nationwide study based on home blood pressure monitoring
Alves, M. A. M., Feitosa, A. D. M., Gomes, M. A. M., de Paiva, A. M. G., Barroso, W. K. S., Miranda, R. D., Barbosa, E. C. D., Brandão, A. A., Diniz, P. G. S., Berwanger, O. B., et al. (2022) · Hypertension Research · doi:10.1038/s41440-022-01103-y · Cited by 14 · see citing works
“that, individually, each specific variable had only a modest ability to predict MH regardless of the defining criteria, which corroborates previously reported data [21].”
Result
The many faces of hypertension in individuals with type 1 diabetes.
Lithovius, R., & Groop, P. (2023) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2023.110564 · Cited by 13 · see citing works
Twenty-four-hour blood pressure and heart rate variability are reduced in patients on left ventricular assist device support
Castagna, F., McDonnell, B. J., Mondellini, G. M., Gaudig, A., Pinsino, A., McEniery, C. M., Stöhr, E. J., Takeda, K., Naka, Y., Uriel, N. Y., et al. (2022) · The Journal of Heart and Lung Transplantation · doi:10.1016/j.healun.2022.02.016 · Cited by 13 · see citing works
Pediatric body mass index trajectories and the risk of hypertension among adolescents in China: a retrospective cohort study
Ge, W., Han, D., Ding, Z., Yi, L., Yang, Z., Wang, X.-N., Xiao, Y., Liang, F., Hai, B., Lv, H., et al. (2022) · World Journal of Pediatrics · doi:10.1007/s12519-022-00626-1 · Cited by 12 · see citing works
“Three separate BP visits can significantly reduce the impact of the “white coat effect” or other confounding factors, and thus may contribute to accurate screening of individuals who require further clinical diagnosis and treatment [11, 12].”
Background
La monitorización ambulatoria de la presión arterial es un instrumento aconsejable para todos los pacientes
de la Sierra, A. (2016) · Hipertensión y Riesgo Vascular · doi:10.1016/j.hipert.2016.06.004 · Cited by 12 · see citing works
Observational study and participant-level meta-analysis on antihypertensive drug treatment-related cardiovascular risk
Asayama, K. (2017) · Hypertension Research · doi:10.1038/hr.2017.60 · Cited by 12 · see citing works
“What if It’s not Just an Item of Clothing?” – A Narrative Review and Synthesis of the White Coat in the Context of Aged Care
Crutzen, C., & Adam, S. (2022) · Psychologica Belgica · doi:10.5334/pb.1138 · Cited by 10 · see citing works
Uric Acid Is Not Associated With Blood Pressure Phenotypes and Target Organ Damage According to Blood Pressure Phenotypes
Cai, A., Liu, L., Siddiqui, M., Zhou, D., Chen, J., Calhoun, D. A., Tang, S., Zhou, Y., & Feng, Y. (2020) · American Journal of Hypertension · doi:10.1093/ajh/hpaa130 · Cited by 11 · see citing works
Mortality risks in different subtypes of masked hypertension in the Spanish ambulatory blood pressure monitoring registry
de la Sierra, A., Ruilope, L. M., Staplin, N., Stergiou, G. S., & Williams, B. (2024) · Journal of Hypertension · doi:10.1097/hjh.0000000000003950 · Cited by 10 · see citing works
“Its prevalence ranges from 5 to 10% among the general hypertensive population, but from 15 to 30% among patients with normal office BP [2].”
Smart cities and smart health: Innovations in home medical devices for efficient healthcare delivery
Cai, T., Ma, J., & Ge‐Zhang, S. (2025) · Results in Engineering · doi:10.1016/j.rineng.2025.105739 · Cited by 11 · see citing works
Prediction of white-coat hypertension and white-coat uncontrolled hypertension using machine learning algorithm
Shih, L.-C., Wang, Y.-C., Hung, M.-H., Cheng, H., Shiao, Y.-C., Tseng, Y.-H., Huang, C., Lin, S., & Chen, J. (2022) · European Heart Journal - Digital Health · doi:10.1093/ehjdh/ztac066 · Cited by 9 · see citing works
“Evidence to date suggests that WCH carries a higher cardiovascular (CV) risk when compared with normotension.4,18,19 Aside from increased CV risk, studies have shown that WCH is also associated with TOD, such as end stage renal disease in non-dialysis chronic kidney disease patients.20 Moreover, the risk of progressio…”
Background
Masked uncontrolled hypertension in patients on maintenance hemodialysis
Liu, W., Wang, L., Sun, Z., Li, X., Zhou, J., Gao, C., Chu, H., Fan, W., Bai, Y., & Yang, J. (2017) · Hypertension Research · doi:10.1038/hr.2017.48 · Cited by 9 · see citing works
Advantages of Ambulatory Blood Pressure Monitoring in Assessing the Efficacy of Antihypertensive Therapy
de la Sierra, A. (2015) · Cardiology and Therapy · doi:10.1007/s40119-015-0043-1 · Cited by 9 · see citing works
“diabetes, and cardiac or renal organ damage [9, 24]; whereas youth, the male sex, smoking, diabetes, and the presence of organ damage are correlated with a higher probability of presenting masked HTN [23, 25].”
Background
Use of Home Blood Pressure Results for Assessing the Quality of Care for Hypertension
Hwang, K. O., Thomas, E. J., & Petersen, L. A. (2018) · JAMA · doi:10.1001/jama.2018.12365 · Cited by 9 · see citing works
Optimization of Ambulatory Blood Pressure Monitoring during Pregnancy: A Path Toward Risk Stratification Improvement and Management of Hypertensive Disorders
Fang, Y., Zuo, L., Li, J., Shi, H., Zhang, R., Han, C., Lv, L., & Zhou, X. (2025) · Reviews in Cardiovascular Medicine · doi:10.31083/rcm27235 · Cited by 9 · see citing works
“In the nonpregnant population, the prevalence of WCH reported in previous studies varies from 20% to 30% [34,35].”
Ruling out white coat hypertension with NT-proBNP: A new paradigm away from blood pressure assessment
Courand, P., Harbaoui, B., Serraille, M., Berge, C., & Lantelme, P. (2016) · International Journal of Cardiology · doi:10.1016/j.ijcard.2016.01.155 · Cited by 8 · see citing works
Two-dimensional speckle-tracking echocardiography-based left atrial strain parameters predict masked hypertension in patients with hypertensive response to exercise
Aung, S. M., Güler, A., Güler, Y., Karabay, C. Y., & Akdemir, İ. (2016) · Blood Pressure Monitoring · doi:10.1097/mbp.0000000000000226 · Cited by 8 · see citing works
A method for blood pressure hydrostatic pressure correction using wearable inertial sensors and deep learning
Colburn, D. A. M., Chern, T. L., Guo, V. E., Salamat, K. A., Pugliese, D. N., Bradley, C., Shimbo, D., & Sia, S. K. (2025) · npj Biosensing · doi:10.1038/s44328-024-00021-y · Cited by 8 · see citing works
Comparison of the antihypertensive efficacy of morning and bedtime dosing on reducing morning blood pressure surge
Zhang, P., Jin, M., Song, X., Wang, Z., Jiang, Y.-H., & Yang, C. (2021) · Medicine · doi:10.1097/md.0000000000024127 · Cited by 7 · see citing works
“5) The pre- and post-treatment SBP andDBP of each patient were measured by ABPM, which is now the gold standard measurement and the most cost-effective strategy for diagnosing hypertension, evaluating true BP level.([14]) ABPM is recognized as a predictor of CV morbidity and mortality superior to office BP measurement…”
Method
Bedtime administration of antihypertensive medication can reduce morning blood pressure surges in hypertensive patients: a systematic review and meta-analysis
Jiang, H., Yu, Z., Liu, J., & Zhang, W. (2021) · Annals of Palliative Medicine · doi:10.21037/apm-21-1405 · Cited by 7 · see citing works
“The following selection criteria were applied to the literature: (I) the study included adult patients with hypertension as diagnosed by SBP ≥140 mmHg or DBP ≥90 mmHg (11); (II) experimental trials of antihypertensive drugs for at least 6 weeks (including calcium channel blockers, angiotensin-converting enzyme inhibit…”
Method
Which out-of-office measurement technique should be used for diagnosing hypertension in prehypertensives?
on behalf of the Turkish Society of Hypertension and Renal Diseases, Ulusoy, Ş., Özkan, G., Arıcı, M., Derici, Ü., Akpolat, T., Şengül, Ş., Yılmaz, R., Ertürk, Ş., & Erdem, Y. (2019) · Journal of Human Hypertension · doi:10.1038/s41371-019-0284-x · Cited by 7 · see citing works
Seasonal variation in blood pressure: what is still missing?
Barbosa, E. C. D., Farina, G. S., Basso, C. S., Camafort, M., Coca, A., & Nadruz, W. (2023) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2023.1233325 · Cited by 8 · see citing works
“MH and WCH may have heterogeneous prevalence in diverse clinical settings and populations, reaching 7%–52% and 9%–54% respectively (12, 13).”
Background
Monitorización ambulatoria de la presión arterial. Situación actual y perspectivas futuras
de la Sierra, A. (2024) · Medicina Clínica · doi:10.1016/j.medcli.2023.12.023 · Cited by 6 · see citing works
Physiotherapy Screening for Referral of a Patient with Patent Foramen Ovale Presenting with Neck Pain as Primary Complaint: A Case Report
Lopez, G., Cataldi, F., Bellin, G., Dunning, J. R., Fernández‐de‐las‐Peñas, C., Galeno, E., Meroni, R., Maselli, F., & Mourad, F. (2023) · Healthcare · doi:10.3390/healthcare11081165 · Cited by 6 · see citing works
Viewpoint: The Case for Non-Invasive Central Aortic Pressure Monitoring in the Management of Hypertension
Kesten, S., Qasem, A., & Avolio, A. P. (2022) · Artery Research · doi:10.1007/s44200-022-00023-z · Cited by 6 · see citing works
“[47] The incidence is increased in the elderly, men, elevated lipids, and obesity [48].”
Background
Prevalence and risk factors of hypertension and diabetes among persons living with HIV in Zambia: results of a national facility‐based cross‐sectional survey
Mandyata, C., Sivile, S., Bosomprah, S., Somwe, P., Zyambo, C. M., Musukuma, M., Mweemba, A., Chavula, M. P., Sichilima, C., Bwembya, P. A., et al. (2025) · Journal of the International AIDS Society · doi:10.1002/jia2.70051 · Cited by 5 · see citing works
“This method was necessary to minimize the influence of short-term variability and the white coat effect, thus producing a more reliable estimate of resting blood pressure [45].”
White coat hypertension is another clinical characteristic of patients with inflammatory bowel disease: A cross-sectional study
Premužić, V., Prijić, R., Jelaković, M., Krznarić, Ž., Čuković‐Čavka, S., & Jelaković, B. (2022) · Medicine · doi:10.1097/md.0000000000029722 · Cited by 5 · see citing works
Predictive Accuracy of 24-Hour Ambulatory Blood Pressure Monitoring Versus Clinic Blood Pressure for Cardiovascular and All-Cause Mortality: A Systematic Review and Meta-Analysis
Soleimani, H., Mohammadi, N. S. H., Namin, S. M., Nasrollahizadeh, A., Azardar, T., Najafi, K., Çilingiroğlu, M., Syed, M., Askari, M. K., Gupta, R., et al. (2025) · Current Hypertension Reviews · doi:10.2174/0115734021337639250203175636 · Cited by 5 · see citing works
American Versus European Hypertension Guidelines: The Case of White Coat Hypertension
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Hipertansiyon Tanısı Olan Hastaların Hastalıkları Hakkındaki Bilgi Düzeyleri ve İlişkili Faktörler
ARIKAN, A., AYDIN, A., Ekerbiçer, H. Ç., KARAAYAÇ, R., ZEYTİNOĞLU, Y., MURATDAĞI, G., SEZER, M. N., ETÇİOĞLU, E., KARADENİZ, F., & Kurban, A. (2020) · Sakarya Medical Journal · doi:10.31832/smj.745870 · Cited by 5 · see citing works
Prevalence of white coat hypertension (WCH) among individuals with elevated clinic blood pressure: A feasibility study
Lim, J. Y., Oka, P., Ong, L., Pitchay, J. B. M., & Ng, W. L. (2025) · Proceedings of Singapore Healthcare · doi:10.1177/20101058251350732 · Cited by 4 · see citing works
Treatment of White Coat HYpertension in the Very Elderly Trial (HYVET 2) - Feasibility of a Randomized Controlled Trial (Study Protocol)
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“WCH is defined as persistently raised clinic blood pressure readings (≥140/90 mmHg) in individuals who have normal HBPM or ABPM readings (<135/85 mmHg) and may affect up to 50% of the population, according to some studies [13,14].”
Association between retinal arterial narrowing and left ventricular diastolic dysfunction in masked hypertensives
Huang, H., Cao, Y., Li, J., Liu, C., Owusu‐Agyeman, M., Chen, B., Li, L., Du, F., Hu, X., Liu, Y., et al. (2020) · Journal of Clinical Hypertension · doi:10.1111/jch.13863 · Cited by 4 · see citing works
How do family physicians measure blood pressure in routine clinical practice
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Masked arterial hypertension: what is known and what expected to be learned?
Gorshkov, A. Y., Александрович, Ф. А., & Drapkina, O. M. (2020) · Russian Journal of Preventive Medicine · doi:10.17116/profmed202023062143 · Cited by 3 · see citing works
Hipertensión de bata blanca. Criterios de abordaje y pronóstico
Bargalló, E. V. (2020) · FMC - Formación Médica Continuada en Atención Primaria · doi:10.1016/j.fmc.2020.03.014 · Cited by 3 · see citing works
Comparing differences and correlation between 24-hour ambulatory blood pressure and office blood pressure monitoring in patients with untreated hypertension
Zhang, Z., Wang, S., Yan, J., Xu, Z., Liang, D., Liu, B., Liang, J., & Chen, M. (2021) · Journal of International Medical Research · doi:10.1177/03000605211016144 · Cited by 3 · see citing works
Ambulatory Blood Pressure Monitoring in HIV-Infected Patients: Usefulness for Cardiovascular Risk Assessment
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Prevalence of White Coat Hypertension in Patients with Chronic Kidney Disease
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“Furthermore, the high prevalence of WCHT among the CKD population leads to misclassification of true BP (13, 14).”
BackgroundResultInfluential
Economic Impact of Ambulatory Blood Pressure Monitoring Compared With Clinical Blood Pressure Monitoring: A Simulation Model
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“19-21 In the ABPM arm of the model, untreated patients with WCH in each year may transition to ABPM-confirmed hypertension in the next year and initiate hypertensive treatment.”
Method
Blood pressure control, hypertension phenotypes, and albuminuria: outcomes of the comprehensive Basel Postpartum Hypertension Registry
Hotz, L., Burkard, T., Rana, A., Wenker, C., Jalanthiran, S., Piattini, L., Strobel, N., Vorster, V., Menzinger, Z., Eichler, S., et al. (2025) · Hypertension Research · doi:10.1038/s41440-025-02191-2 · Cited by 1 · see citing works
“White-coat hypertension occurred in less than 5% of our cohort at 12 months, lower than reported in other national registries, likely due to the use of unattended of ﬁ ce blood pressure monitoring, which is known to reduce white-coat hypertension [35].”
Blood Pressure in Patients Attending an Out-of-Hours Dental Clinic
Iijima, Y., Yamada, M., Nakayama, N., Takahashi, T., Hino, S., Sano, M., Horie, N., & Kaneko, T. (2025) · Cureus · doi:10.7759/cureus.92878 · Cited by 1 · see citing works
“When measuring blood pressure in an outpatient setting, white coat hypertension should be considered [19].”

A0241 Use of Ambulatory Blood Pressure Monitoring in the Diagnosis of White Coat and Masked Hypertension
Chen, X., Hu, Z., Chang, G., Zuo, J., Li, M., Chen, J., Chu, S., & Wang, J. (2018) · Journal of Hypertension · doi:10.1097/01.hjh.0000548381.53388.ed
Ambulatory blood pressure monitoring in daily clinical practice – the Spanish ABPM Registry experience
Gorostidi, M., Banegas, J. R., de la Sierra, A., Vinyoles, E., Segura, J., & Ruilope, L. M. (2015) · European Journal of Clinical Investigation · doi:10.1111/eci.12565 · Cited by 44 · see citing works
Self-citation
S-46-1: WHITE-COAT HYPERTENSION AND MASKED HYPERTENSION: OVERALL EVIDENCE AND PERSPECTIVE FROM USA
Shimbo, D. (2023) · Journal of Hypertension · doi:10.1097/01.hjh.0000913720.74616.35
WHITE-COAT EFFECT AND MASKED HYPERTENSION IN HIGH-NORMAL OFFICE BLOOD PRESSURE: RESULTS OF THE HUNGARIAN ABPM REGISTRY
Nemcsik, J., Takács, J., Farsang, C., Simon, A., Páll, D., Torzsa, P., Dolgos, S., Koller, Á., & Járai, Z. (2024) · Journal of Hypertension · doi:10.1097/01.hjh.0001020056.91374.78
Prevalence of masked uncontrolled and treated white-coat hypertension defined according to the average of morning and evening home blood pressure value: from the Japan Home versus Office Measurement Evaluation Study
Obara, T., Ohkubo, T., Kikuya, M., Asayama, K., Metoki, H., Inoue, R., Oikawa, T., Komai, R., Murai, K., Horikawa, T., et al. (2005) · Blood Pressure Monitoring · doi:10.1097/00126097-200512000-00005 · Cited by 57 · see citing works

Authors: Gorostidi, M., Vinyoles, E., Banegas, J. R., & de la Sierra, A.
Affiliations: Hospital Universitario Central de Asturias (ES)
Universitat de Barcelona (ES)
Universidad Autónoma de Madrid (ES)
ORCID: Gorostidi, Manuel
Vinyoles, Ernest
Banegas, José R
Venue: Hypertension Research
Publisher: Springer Science and Business Media LLC
Published: 2014-10-16
Volume: 38
Issue: 1
Pages: 1-7
ISSN: 0916-9636 (ISSN-L)
1348-4214
DOI: 10.1038/hr.2014.149
OpenAlex: W2077649372
Cited by: 141
References: 47
Citations by year: 2026: 6 · 2025: 14 · 2024: 10 · 2023: 9 · 2022: 19 · 2021: 10 · 2020: 19 · 2019: 10 · 2018: 13 · 2017: 13 · 2016: 11 · 2015: 7
FWCI: 1.66
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.springer.com/tdm (tdm)
Locations: Hypertension Research (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
Keywords: white coat hypertension, masked hypertension, ambulatory blood pressure monitoring, office blood pressure, hypertension misclassification, hypertension control, cardiovascular risk factors
MeSH terms: Humans, Prevalence, Blood Pressure Monitoring, Ambulatory, White Coat Hypertension, Masked Hypertension

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Prevalence of white-coat and masked hypertension in national and international registries

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