ABSTRACT
INTRODUCTION Office blood pressure is usually higher than blood pressure measured out of the office, which has been ascribed to the alerting response, anxiety, and/or a conditional response to the unusual situation,1 and in which regression to the mean may play a role. Although several factors may be involved in office or out-of-office blood pressure modulation,2 the difference between office and out-of-office blood pressure is usually referred to, although somewhat improperly,2,3 as the “white-coat effect,” whereas “whitecoat” or “isolated office” or “isolated clinic hypertension” refers to the condition in which blood pressure is elevated in the office at repeated visits and normal out of the office, either on ambulatory blood pressure monitoring or home blood pressure measurement.4-6 Elevation of blood pressure in the first and last hour of ambulatory blood pressure monitoring has also been used for identifying the white-coat response and white-coat hypertension.7 Conversely, blood pressure may be normal in the office and abnormally high out of the medical environment, which is termed “masked” or “isolated ambulatory hypertension.”5,6,8 The terms “true” or “consistent normotension” and “sustained hypertension” are used when both types of blood pressure measurement are, respectively, normal or abnormal.
