The 2017 Hypertension Clinical Practice Guidelines recommend out-of-clinic BP monitoring to screen for white coat and masked hypertension among adults not taking antihypertensive medication and white coat effect and masked uncontrolled hypertension among adults taking antihypertensive medication. We estimated the percentage of US adults meeting criteria for out-of-clinic BP monitoring by the American College of Cardiology/American Heart Association guideline using the 2011 to 2014 National Health and Nutrition Examination Survey (n=9623). Among US adults not taking antihypertensive medication, 92.6% (95% CI, 90.7%-94.1%) with systolic/diastolic BP ≥130/80 mm Hg met criteria for out-of-clinic BP monitoring to screen for white coat hypertension and 32.8% (95% CI, 30.4%-35.3%) with systolic/diastolic BP<130/80 mm Hg met criteria to screen for masked hypertension. Criteria for out-of-clinic BP monitoring to screen for white coat hypertension were less often met at an older age and did not differ by race/ethnicity or sex. The proportion meeting criteria for out-of-clinic BP monitoring to screen for masked hypertension was higher at an older age, among men versus women and non-Hispanic blacks and whites versus non-Hispanic Asians or Hispanics. Among US adults taking antihypertensive medication, 12.5% (95% CI, 10.5%-14.9%) with systolic/diastolic BP ≥130/80 mm Hg met criteria to screen for white coat effect and 57.4% (95% CI, 52.7%-62.1%) with systolic/diastolic BP<130/80 mm Hg met criteria to screen for masked uncontrolled hypertension. Criteria for out-of-clinic BP monitoring to screen for white coat effect was more commonly met at an older age and among non-Hispanic blacks than non-Hispanic whites and to screen for masked uncontrolled hypertension in older adults and men. In conclusion, ≈103.8 million US adults (45.8%) met the 2017 Hypertension Clinical Practice Guidelines criteria for out-of-clinic BP monitoring.
Keywords: American Heart Association; blood pressure; cardiovascular disease; masked hypertension; white coat hypertension.