Masked Hypertension: More Common (and Dangerous) than White Coat Syndrome

December 19, 2016
Masked Hypertension - Dr. Axe

You might have heard of a condition called “white coat syndrome,” where people’s blood pressure readings are higher at the doctor’s office than at home. It’s attributed to the nervousness some individuals feel when seeing the doctor, which causes the blood pressure to temporarily rise. But there’s another condition that’s actually quite common and can lead doctors to miss patients at risk for high blood pressure. It’s called masked hypertension and high blood pressure symptoms related to the condition can be a little tricky to pinpoint.


What Is Masked Hypertension?

Masked hypertension occurs when a person’s at-home blood pressure reading is higher than at the doctor’s office. And a recent study has found that it’s a lot more common than white coat syndrome. (1) That means patients who are at risk of, or already suffering from, high blood pressure might be slipping through the cracks because their measurements are coming in too low at the doctor’s office.

The study, conducted by researchers from Stony Brook University and Columbia University, examined 888 male and female participants with a median age of 45, none of whom were already taking medication to lower their blood pressure.

The participants wore a small, portable blood pressure cuff for 24 hours of ambulatory, or around the clock, monitoring as they went about their day-to-day activities, with readings taken every half hour. This round-the-clock surveillance is a better, more accurate predictor of future heart disease than clinical blood pressure. In addition to the cuff, the participants also visited the clinic three times for blood pressure readings.

The results were startling. The average of all the measurements taken while participants were awake with the cuff, known as their ambulatory blood pressure, was actually higher than in-office averages, the opposite of white coat syndrome. In fact, about 16 percent of the participants with normal clinical blood pressure wound up having high blood pressure the rest of the day; only about 1 percent of patients wound up with white coat hypertension.

The study also found that masked hypertension was most common in males and people with pre-hypertension or borderline hypertension (where blood pressure readings are on the edge of being too high).

Additionally, younger participants at a normal weight suffered from masked hypertension more than their older, overweight counterparts. If someone relies only on these clinical blood pressure readings, their high blood pressure might go unnoticed until more serious problems, like coronary heart disease, a stroke or diabetes, arise.

So what does this mean for your blood pressure? The study authors suggest physicians remember that in-office blood pressure readings are likely to underestimate, not overestimate, blood pressure ratings. Additionally, those likeliest to suffer from masked hypertension are the ones whose in-office readings are closest to high blood pressure levels. For these patients, 24-hour ambulatory blood pressure monitoring would be helpful. (2)

Unfortunately, there aren’t many signs of masked hypertension to look out for, though if there is a history of high blood pressure in your family, it’s critical to let your doctor know. You can also naturally reduce your risk by following a blood pressure diet.

Filling your plate with fruits, veggies, olive oil, and omega-3 foods, like fresh, wild-caught fish, can help lower blood pressure. If you eat grains, sprouted or 100-percent whole grains are your best bet. Lowering sodium intake is also important, as excess sodium in most Americans’ diets doesn’t come from a salt shaker, but rather the sodium added to processed, ultra-processed foods.

Finally, if you want to take things an extra step, you can get purchase an at-home blood pressure cuff to monitor your levels at home.


Final Thoughts on Masked Hypertension

  • Masked hypertension occurs when a person’s at-home blood pressure reading is higher than at the doctor’s office.
  • It is the opposite of white-coat syndrome, where people’s blood pressure is more elevated at the doctor’s office but normal otherwise.
  • Masked hypertension is about 16 times more prevalent than white-coat syndrome, according to a 2016 study.
  • Masked hypertension strikes men more often than women; it’s more common among younger people at a normal weight compared to older, overweight people.
  • If you are concerned or have a family history of high blood pressure, ask your doctor about 24-hour blood pressure monitoring to get a more realistic picture of your blood pressure.

Read Next: Top 15 Anti-Inflammatory Foods


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