Cardiovascular Risk Assessment
This patient has intermediate cardiovascular risk based on the discrepancy between clinic and home blood pressure readings, which indicates white-coat hypertension. 1
Blood Pressure Classification and White-Coat Hypertension
The clinic reading of 140/80 mmHg meets the threshold for hypertension (≥140/90 mmHg), while the home reading of 130/80 mmHg falls into the high-normal range according to European guidelines 1
This pattern is diagnostic of white-coat hypertension, defined as elevated office blood pressure (≥140/90 mmHg) with normal ambulatory or home blood pressure values 1
The home blood pressure threshold for hypertension is 130-135/85 mmHg, and this patient's consistent home reading of 130/80 mmHg is at the lower end of this range 1, 2
Cardiovascular Risk Stratification
White-coat hypertension carries a cardiovascular disease risk that is similar to normal blood pressure and substantially lower than sustained hypertension, placing this patient in an intermediate risk category. 3
Patients with white-coat hypertension have a cardiovascular risk profile that is lower than those with sustained hypertension but may be slightly elevated compared to true normotensives 1
The home blood pressure of 130/80 mmHg represents "high-normal" blood pressure, which is associated with approximately 2-fold increased cardiovascular risk compared to optimal blood pressure (<120/80 mmHg), but significantly less than sustained hypertension 4
High-normal blood pressure (130-139/80-89 mmHg) carries a risk-factor-adjusted hazard ratio of 1.6-2.5 for cardiovascular disease compared to optimal blood pressure 4
Clinical Implications
Drug treatment is not necessary for white-coat hypertension because the cardiovascular risk is probably low, and these patients should be monitored more frequently than the general population 1
The patient requires lifestyle modifications including weight management, dietary changes (DASH or Mediterranean diet), sodium restriction, physical activity, and alcohol moderation 2
Continued home blood pressure monitoring is essential to detect any progression to sustained hypertension (masked hypertension), which would substantially increase cardiovascular risk 3
The patient should be reassessed periodically to ensure home blood pressure readings remain stable and do not progress to sustained hypertension 1
Key Pitfall to Avoid
The critical error would be treating this patient as having sustained hypertension based solely on clinic readings, which would result in unnecessary medication exposure and potential adverse effects without corresponding cardiovascular benefit 1, 3