In our daily outpatient work, we find that some patients have elevated blood pressure when their blood pressure is measured in the clinic, but their blood pressure is normal when they take their own blood pressure at home or when they monitor their blood pressure with a 24-hour ambulatory blood pressure monitor. “White coat hypertension”. The reasons for this are as follows: First, the patient has a genetic characteristic of overreacting to stress and is prone to tension, anxiety or conditioned reflexes to special environments; second, the patient’s renin-angiotensin-aldosterone system is easily activated, with increased secretion of blood catecholamines, aldosterone and other blood pressure hormones; third, the patient is not accustomed to the hospital environment, and the medical staff’s attitude, language and mutual communication methods can affect blood pressure. . According to statistics, the overall incidence of office hypertension is 9%-16%. There has not been a clear statement on whether to give treatment for young and middle-aged office hypertension, and there has always been a debate. 1999 American hypertension guidelines, and European hypertension guidelines both state that the need for treatment for simple office hypertension should be decided based on the presence of other clinical risk factors and the presence of damage to important organs, and close follow-up is recommended; 2013 European hypertension guidelines state that There is little evidence for pharmacological treatment of office hypertension, and treatment regimens should be individualized with close follow-up. So for young and middle-aged friends with only mildly elevated office blood pressure and no other cardiovascular risk factors, should they be treated with pharmacological interventions? The recently published Hypertension And Ambulatory Recording Venetia Study (HARVST) provides the answer: observation and follow-up is the best strategy for treating office hypertension when it has been determined that treatment has been initiated. This study confirmed that blood pressure in young and middle-aged adults with simple in-office hypertension may remain normal after 10 years, and that ambulatory blood pressure monitoring reveals a gradual decrease and possible return to normal. These findings are a reminder that some in-office hypertension does not require antihypertensive therapy. Hypertension in youth is quite different from hypertension in the elderly, where the cardiovascular risk is increasing. In clinical work we often see soccer or rugby players who have mildly elevated blood pressure, but further analysis reveals that this is beneficial for them, which allows the athletes to have greater endurance and therefore does not require them to reduce their exercise levels. One of the very important findings of this study is that when you are not sure if youth office hypertension will progress to hypertension, it is best to observe and follow up regularly and to assess patients frequently and repeatedly so that they are not subject to premature pharmacological intervention. So when to start antihypertensive therapy? It is not entirely clear how long in-office hypertension should be observed along with lifestyle changes before initiating blood pressure lowering, and based on data from the HARVEST study, their goal was to assess and determine how well the normal range of automated blood pressure monitoring predicted long-term normotension. Participants in the HARVEST study whose blood pressure was at level I (140-159/90-99 mmHg) were observed and followed up to further determine whether they had office hypertension, occult hypertension, or persistent hypertension. A total of 1104 participants with an average age of 33 years, 74% of whom were men because men in this age group have slightly higher blood pressure than women, were free of diabetes, had no previous cardiovascular history, and had not received medication to lower their blood pressure. Follow-up value was determined based on three blood pressure values, baseline blood pressure measured at months 1.2.3.6 and every six months thereafter until the end of the study, for up to 20 years. They were divided into 2 groups according to the values of blood pressure measured. At the end of the study, there were 214 cases with normal blood pressure and 890 cases that progressed to hypertension and required medication during the observation follow-up. Those who maintained normal blood pressure were followed up for an average of 11 years, and those who progressed to hypertension were followed up for an average of 7 years. Compared with those who developed hypertension, those with normal blood pressure were younger (age 29.5 vs. 33.9 years) and had lower basal blood pressure (142/91 mmHg vs. 146/94 mmHg), and those who maintained normal blood pressure also had a good endocrine metabolic status, such as a lower body mass index (24.5 vs. 29.6), lower blood glucose levels, lower triglycerides and higher HDL levels, more physical activity, etc. In the normotensive group, mean blood pressure levels decreased by 7/5 mm Hg after 1 year and by 14/8 mm Hg after 11 years. The majority of those who maintained normal blood pressure were found to be office hypertensive compared with those who progressed to hypertension (19% vs 35%, P<0.001< span="">). During the first 3 months of follow-up, 42% of those with normal blood pressure remained normal at the end of the study, and 22% of those with high blood pressure eventually all developed hypertension and required medication. At the end of the study, automatic blood pressure monitoring showed virtually no change in blood pressure (1/1 mmHg) over the 11-year period in those with normal blood pressure, while those who progressed to hypertension had increased blood pressure (4/3 mmHg). Therefore, basal blood pressure, mean blood pressure from automated blood pressure monitoring, and 3-month blood pressure levels are meaningful predictors of future progression to hypertension. Progression to hypertension is more common in patients with glucose abnormalities, atrial fibrillation, cardiovascular events, and overweight. From this experiment above, we conclude that the strategy that should be used for young and middle-aged people with simple office hypertension is follow-up and observation rather than premature pharmacological intervention, and that there is a proportion of office hypertension in which blood pressure can remain normal for a long time; self-measured blood pressure or automatic blood pressure monitoring helps to identify office blood pressure, occult hypertension and persistent hypertension, so that patients with hypertension who really need treatment can receive timely By helping to identify office hypertension, occult hypertension and persistent hypertension through self-monitoring or automated blood pressure monitoring, patients with hypertension who really need treatment can receive timely antihypertensive treatment so that a portion of the population with pure office hypertension, which is actually normal blood pressure, will not be subject to excessive intervention.