Hypertension — KFP-style written assessment

KFP 1 (10 marks)

A 49-year-old teacher attends for a 'blood pressure check'. Two clinic readings across two visits average 156/96 mm Hg. She is a non-smoker with normal examination. A 7-day home monitor averages 130/80 mm Hg. ^{[2] [4]}

1. State her phenotype and the diagnostic thresholds that define it. (3) ^[4]
2. Quantify her cardiovascular risk relative to true normotension and outline management. (4) ^{[4] [5]}
3. Her husband, measured the same week, averages 138/88 mm Hg at home but reads 136/86 in your clinic. Name the phenotype and its prognosis. (3) ^{[3] [4]}

Model answers

1. White-coat hypertension: clinic blood pressure 140/90 mm Hg or higher with normal home or daytime ambulatory readings below 135/85 mm Hg. ^[4]
2. Untreated white-coat hypertension carries a 38% increased risk of cardiovascular disease and 20% increased total mortality versus normotension — it is not benign. Management: lifestyle intervention, formal absolute-risk assessment, annual out-of-office monitoring, and drug therapy only when overall risk or organ damage tips the balance. ^[5]
3. Masked hypertension — clinic readings below 140/90 concealing out-of-office averages of 135/85 mm Hg or higher. In population data masked hypertension was five times commoner than white-coat hypertension (17.8% vs 3.3%) and carried roughly double the event risk of sustained normotension (adjusted hazard ratio 2.03). It warrants treatment as sustained hypertension. ^[4]