Should sleep blood pressure be used as a criterion to define white-coat hypertension?

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The term white-coat hypertension was first used in the 1980s to refer to the presence of blood pressure (BP) not in the hypertensive range when measured outside of the clinic setting among individuals with BP in the hypertensive range measured in the clinic setting [1]. Traditionally, ambulatory BP monitoring (ABPM) conducted over a 24-h period has been used to identify white-coat hypertension with out-of-clinic BP defined using the mean of readings during the awake period or over the entire ABPM period (i.e. 24-h BP). Previous studies have estimated that up to 65% of people with clinic-measured SBP/DBP at least 140/90 mmHg have white-coat hypertension (i.e. mean awake SBP/DBP <135/85 mmHg or 24-h SBP/DBP <130/80 mmHg) with most prevalence estimates between 20 and 50% [2]. There has been substantial debate about whether white-coat hypertension is benign or not. Most, but not all, studies have suggested that white-coat hypertension is associated with no or only a modestly increased cardiovascular disease risk when compared with sustained normotension (i.e. BP in the normotensive range inside and outside of the clinic setting) [3,4].

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