Special Types of Hypertension

A formal diagnosis of clinical hypertension requires an average of two readings ≥140/90 mmHg obtained on two separate clinical visits.

White Coat Hypertension (Isolated Clinic Hypertension): Characterized by

·   elevated office blood pressure (≥140/90 mmHg)

·   BUT normal mean awake ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) values (<135/85 mmHg).

·   Attributed to a conditioned anxiety response in clinical environments; associated with normal/ slightly elevated cardiovascular risk, it does not require pharmacologic HT treatment.

Masked Hypertension: Characterized by

·   normal office blood pressure values (<140/90 mmHg) alongside

·   elevated daytime home or ambulatory monitoring values (>135/85 mmHg).

·   This HT carries as much cardiovascular risk, as sustained hypertension and needs treatment

Nocturnal Hypertension:

Physiologically, blood pressure drops during sleep, with a normal nocturnal fall of ≥10% relative to daytime values.

·   A nocturnal drop of <10%,

·   a nocturnal rising pattern, or

·   an extreme nocturnal drop (>20%)

All correlate with adverse cardiovascular outcomes and target organ damage.

This type of HT can only be identified using 24-hour Ambulatory Blood Pressure Monitoring 

References

Bickley, L. S., & Szilagyi, P. G. (2020). Bates' Guide to Physical Examination and History Taking (13th ed.). Wolters Kluwer.

Government of India (2016). Standard Treatment Guidelines - Hypertension. Ministry of Health & Family Welfare, New Delhi.

India Hypertension Control Initiative; Guide for Medical Officers. Ministry of Health & Family Welfare, New Delhi.

Cavallini, M. C., Roman, M. J., Blank, S. G., Pini, R., Pickering, T. G., & Devereux, R. B. (1996). Association of the Auscultatory Gap with Vascular Disease in Hypertensive Patients. Annals of Internal Medicine, 124(10), 877–883.

Askey, J. M. (1974). The Auscultatory Gap in Sphygmomanometry. Annals of Internal Medicine, 80(1), 94–97.