American Board of Internal Medicine (ABIM) Certification Practice Exam

When a patient presents with white coat hypertension, what is the next best step in management?

1. Initiate antihypertensive medication

2. Recommend lifestyle changes

3. Perform ambulatory blood pressure monitoring

4. Schedule a follow-up visit in one month

The correct answer is: Perform ambulatory blood pressure monitoring

In cases of white coat hypertension, where a patient exhibits elevated blood pressure readings in a clinical setting but normal readings outside of it, the next best step in management is to perform ambulatory blood pressure monitoring. This method allows for the assessment of blood pressure patterns over a 24-hour period, providing a clearer picture of the patient’s blood pressure in their usual environment, free from the stressors of a medical setting. Obtaining this information is critical, as it helps distinguish between true hypertension, which may require treatment, and situational anxiety-induced elevations in blood pressure. The results from ambulatory monitoring can guide further management, helping to avoid unnecessary medication initiation in patients who may not actually have sustained high blood pressure. In contrast, initiating antihypertensive medication without confirming a diagnosis of hypertension may lead to overtreatment and potential side effects. Lifestyle changes can certainly be recommended but are typically not the immediate next step unless there is a clear diagnosis that warrants them. Scheduling a follow-up visit in one month may delay necessary interventions and does not address the immediate concern of obtaining accurate blood pressure measurements. Therefore, the implementation of ambulatory blood pressure monitoring is essential in guiding appropriate management for patients suspected of white coat hypertension.