A single raised clinic blood pressure is not a diagnosis. White-coat effect is common, and so is masked hypertension, where the clinic reading is normal but home readings are high. Home or ambulatory monitoring settles which it is.
For home monitoring, ask the patient to use a validated upper-arm device, sitting quietly for five minutes, taking two readings a minute apart morning and evening for about a week, and discarding the first day. Average the rest. Home averages run lower than clinic values, so the threshold for hypertension is lower — 135/85 mmHg rather than 140/90.
- Confirm a raised clinic reading with home or ambulatory monitoring before diagnosing hypertension
- Use a validated upper-arm cuff of the right size
- Average two readings morning and evening over about a week, ignoring day one
- Use 135/85 mmHg as the home threshold, not 140/90
Why it matters
As categories widen, out-of-office confirmation is what stops overtreatment of white-coat readings.
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