Masked hypertension occurs when a person has a normal blood pressure reading in the doctor’s office but high blood pressure at home. Doctors may suspect this condition when people report high blood pressure readings after using at-home monitors.

Blood pressure varies throughout the day depending on a person’s activities. Normal blood pressure is less than 120/80 millimeters of mercury (mm Hg). Doctors consider blood pressure high when a person consistently has systolic readings of 130 mm Hg or above or diastolic readings of 80 mm Hg or above.

High blood pressure is also known as hypertension.

For some people, high blood pressure readings only happen when a person is outside of the doctor’s office. It can be challenging to recognize masked hypertension when it does not occur during medical checkups.

This article explains masked hypertension and its symptoms and causes. It also examines how doctors diagnose and treat masked hypertension and how often it occurs in the general population.

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Masked hypertension is when an individual’s blood pressure readings are normal during a medical check at the doctor’s office but are elevated at home or in other environments.

The opposite of masked hypertension is white coat hypertension. This condition occurs when a person’s blood pressure readings are high in the doctor’s office but are at their usual level in other settings, such as at home.

Doctors call it white coat hypertension because being in the presence of a doctor or other healthcare professional – who often wear white coats – can cause a person to experience stress, leading to falsely high blood pressure readings.

Learn more about anxiety and high blood pressure.

A 2018 study estimates that 14–66% of people have masked hypertension. The prevalence estimates in this study relied on blood pressure monitor readings during the day and while asleep and defined hypertension according to United States and European guidelines.

Why are Black Americans more likely to have high blood pressure?

People should regularly check their blood pressure readings because hypertension does not generally cause symptoms until someone experiences severe health complications, such as stroke or heart failure.

According to the World Health Organization (WHO), people with very high blood pressure may experience symptoms such as:

  • nausea
  • vomiting
  • blurred vision
  • dizziness
  • anxiety
  • severe headaches
  • chest pain
  • confusion
  • difficulty breathing
  • abnormal heart rhythm

Learn more about the symptoms of high blood pressure.

Researchers do not know the exact cause of masked hypertension. However, studies indicate that people who smoke, consume excessive alcohol, and experience stress at work are more likely to develop it.

Factors that could increase a person’s risk of masked hypertension may include:

Learn more about high blood pressure.

Advances in wearable health-tracking technology allow individuals to track their blood pressure in multiple scenarios. They can easily determine whether their blood pressure is high outside the doctor’s office using blood pressure monitors at home.

If home blood pressure monitors show people have high blood pressure readings compared to those during medical checkups, doctors may perform further testing to confirm a diagnosis.

Doctors may recommend tests such as:

  • Ambulatory monitoring: This method measures blood pressure continuously for 24 hours, even while sleeping. The data helps healthcare professionals get an accurate picture of a person’s blood pressure numbers.
  • Laboratory tests: Doctors may order blood and urine tests to check for conditions that may cause hypertension or worsen it. They may test blood sugar and cholesterol levels and check kidney, liver, and thyroid function.
  • Electrocardiogram (ECG): Healthcare professionals use an ECG to monitor heart rhythm and electrical activity. It helps detect problems with heart rate and heart rhythm.
  • Echocardiogram: This test uses sound waves to create images of the heart. It can identify common hypertension-related complications, such as heart muscle damage and thickened heart walls.

Learn about more tests for diagnosing pulmonary hypertension.

Doctors may recommend lifestyle and dietary changes and medications to help manage hypertension.

Lifestyle and dietary changes may include:

If lifestyle and dietary changes do not help lower blood pressure, a doctor may suggest medications, including:

Many people may need to take a combination of two or more medicines to manage hypertension.

Learn more about high blood pressure medications here.

A person should check their blood pressure regularly. How often it needs checking depends on a person’s age and overall health.

If individuals consistently have high blood pressure readings on an at-home monitor, they should contact a doctor for advice.

People should seek emergency care if they have high blood pressure readings and experience any of the following symptoms:

  • severe headache
  • vision changes
  • chest pain
  • difficulty breathing
  • numbness or weakness
  • difficulty speaking

Learn more about hypertensive emergencies here.

Masked hypertension occurs when a person has a normal blood pressure reading at the doctor’s office but a high reading at home or in other environments. It is the opposite of white-coat hypertension.

Researchers are uncertain of the precise cause of masked hypertension, but smoking, excessive alcohol drinking, and job-related stress may play a role.

Masked hypertension typically has no symptoms until it causes heart damage and other complications. However, people may detect hypertension using at-home blood pressure monitors and report their findings to a healthcare professional.

Doctors may recommend people try lifestyle and dietary changes to lower their blood pressure, such as exercising regularly and following the DASH eating plan. They may suggest medications for persistent hypertension.