White coat hypertension, as many people know by now, refers to office hypertension, in which the patient’s blood pressure is elevated only when measured in the office and normalized outside the office. It is an intermediate state between normal blood pressure and persistent hypertension, with an increased likelihood of developing persistent hypertension. Treatment of White Coat Hypertension There is already a consensus on lifestyle intervention for White Coat Hypertension, which includes smoking cessation and alcohol restriction, reducing and controlling body weight, rationalizing diet, reducing sodium intake, supplementing potassium, increasing exercise, and reducing mental stress. There are no clear recommendations on the timing and modalities of pharmacologic intervention in this population, pending further evidence-based evidence. White coat phenomenon is different from white coat hypertension White coat phenomenon only means that the patient’s blood pressure is elevated in the office, and his or her blood pressure outside the office may be elevated or normal; it may occur in the white coat hypertensive population, as well as in the normotensive and persistent hypertensive population. It is now widely recognized that the white coat phenomenon can cause an increase in blood pressure in the office, thus overestimating the patient’s true blood pressure level, leading to over-diagnosis and over-treatment, and bringing a heavy economic and psychological burden to the society and the family. Masked hypertension, have you heard of it? Listeners should not be alarmed, masked hypertension, as the name suggests, is a hidden hypertension that hides its true colors, also known as reverse white coat hypertension. It refers to a normal blood pressure in the office and a dynamic blood pressure that is higher than the normal blood pressure standard. The prevalence of masked hypertension in the population ranges from 7.6% to 23.0%, and the prevalence increases significantly with age. In China, some scholars studied 694 Jiangning people and found that the prevalence of masked hypertension was 10.8%, and the prevalence of masked hypertension was significantly higher in hypertensive people who had already received antihypertensive treatment. Thus masked hypertension is a common hypertensive condition in the population. Masked hypertension is more dangerous In Finland, 2,046 volunteers were followed up for up to 7.5 years, recording office blood pressure, home self-measurement, and assessing their risk factors. Masked hypertension was found to have a higher risk of cardiovascular events and risk of all-cause mortality compared with white coat hypertension (risk ratios 1.64, P=0.05 and 2.09, P=0.01). Thus masked hypertension has a higher cardiovascular risk relative to white coat hypertension and normal blood pressure. The pathogenesis of masked hypertension is not yet clear, and numerous studies have found that increased sympathetic excitability, smoking, alcoholism, lack of physical activity, and inflammatory activation are all closely related to the occurrence and development of masked hypertension. In addition, some researchers have confirmed that high body mass index, family history of early-onset cardiovascular disease, mental stress and depression are also risk factors for masked hypertension. How to treat masked hypertension Compared with white coat hypertension, the treatment of masked hypertension is more important because the target organ damage caused by masked hypertension is more obvious. Clinical treatment for masked hypertension is mostly conventional antihypertensive treatment. Reducing mental anxiety and lifestyle interventions are also important in masked hypertension. The probability of white coat hypertension and masked hypertension developing into persistent hypertension, diabetes mellitus, and other chronic diseases is significantly higher than that of the normal blood pressure population, so we need to identify and intervene early through the three-dimensional diagnosis of in-office blood pressure, home self-testing blood pressure, and ambulatory blood pressure.