Table 4: High blood pressure phenotypes according to circumstancial high blood pressure.

Phenotype

White coat high blood pressure

Masked high blood pressure

Definition

Normal office blood pressure and normal out-of-office blood pressure.

Factors such as smoking, alcoholism, physical inactivity, exaggerated response to exercise (exercise high blood pressure), interpersonal relationships, mental anxiety and work stress.

Etiology

Psychological factors (stress, anxiety)

Significant association between masked phenomenon and indirect cardiovascular outcomes, such as left ventricular hypertrophy, increased carotid intima-media thickness, albuminuria, aortic stiffness, high pulse wave velocity, silent cerebral infarcts, and early cerebral infarcts, hypertensive retinal changes.

Pathophysiology

Poorly understood. Hypothesis of involvement of the sympathetic and endocrine system.

Variable

Prognosis

Increases the risk of sustained high blood pressure compared to normotensives. Causes target organ damage compared to normotensives. Some studies have found an increased cardiovascular risk compared to normotensive patients.

Increased cardiovascular risk

Treatment

Correction measures in risk factors.

Pharmacology should be individualized according to the presence of risk factors and target organ damage.

Pharmacological, studies with ACEI and ARB.

ESH = European Society high blood pressure; ACEI = Angiotensin-converting enzyme inhibitors;

ARB = Angiotensin receptor blockers; BB = Beta-blockers.