A 35-year-old asymptomatic woman attends a health camp in Delhi for routine screening. Her blood pressure is 145/92 mmHg on two separate occasions, 2 weeks apart. She has no symptoms of hypertension and no prior history of elevated BP. Laboratory investigations show normal renal function and normal lipid profile. What is the most appropriate next step in management?

Explanation

## Diagnostic Confirmation in Asymptomatic Hypertension Screening **Key Point:** In an asymptomatic individual with elevated BP readings on screening, the diagnosis must be confirmed before initiating pharmacotherapy. ABPM is the gold standard for confirming sustained hypertension and ruling out white-coat hypertension. ### Screening vs. Diagnosis Screening identifies individuals at risk; diagnosis requires confirmation. A single elevated reading or even two office readings are insufficient to diagnose hypertension in an asymptomatic person. **High-Yield:** White-coat hypertension (elevated office BP, normal out-of-office BP) occurs in ~20–30% of screened individuals. ABPM or home BP monitoring (HBPM) is essential to avoid overdiagnosis and unnecessary medication. ### Rationale for ABPM 1. Confirms true hypertension (daytime average ≥135/85 mmHg or 24-hour average ≥130/80 mmHg) 2. Assesses BP variability and nocturnal dipping pattern 3. Guides risk stratification and treatment decisions 4. Cost-effective compared to unnecessary long-term therapy **Clinical Pearl:** Guidelines recommend ABPM or HBPM before initiating treatment in asymptomatic individuals with stage 1 hypertension (140–159/90–99 mmHg) to avoid overtreatment. ### Treatment Threshold - Symptomatic or high-risk patients: treat immediately - Asymptomatic with confirmed sustained hypertension: lifestyle modification first, then pharmacotherapy if BP remains elevated after 3–6 months - Asymptomatic with white-coat hypertension: lifestyle modification only; reassess periodically [cite:Park 26e Ch 8]