{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T15:06:52Z","timestamp":1784128012726,"version":"3.55.0"},"reference-count":8,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Brazilian National Council for Scientific and Technological Development","award":["310869\/2021-8"],"award-info":[{"award-number":["310869\/2021-8"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The 2025 American Heart Association\/American College of Cardiology blood pressure guideline (2025-AHA\/ACC-BP guideline) recommends out-of-office blood pressure (BP) assessment to exclude white-coat hypertension (WCH) in untreated and white-coat effect (WCE) in treated individuals among adults with office BP (OBP) ranging between 130\/80-&amp;lt;160\/100 mmHg, but its real-world diagnostic performance remains incompletely characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We evaluated the performance of 2025-AHA\/ACC-BP guideline-recommended OBP thresholds for screening WCH\/WCE among 147,404 Brazilian adults with OBP\u2009\u2265\u2009130\/80mmHg, including 86,692 untreated (29.7% WCH) and 46,229 treated (29.2% WCE) individuals who underwent HBPM and 10,475 untreated (46.2% WCH) and 4,008 treated (49.4% WCE) individuals who underwent ABPM. OBP ranges combining \u2265130\/80mmHg with progressively lower upper limits (&amp;lt;160\/100, &amp;lt;150\/95, &amp;lt;150\/90, and &amp;lt;140\/90 mmHg) were evaluated. The performance of OBP intervals to detect WCH\/WCE was assessed using sensitivity, specificity, and area under the receiver operating characteristic curve (AUC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the HBPM cohort, OBP\u2009\u2265\u2009130\/80-&amp;lt;160\/100 mmHg yielded sensitivity, specificity, and AUC of 95%, 25%, and 0.600 in untreated and 94%, 28%, and 0.610 in treated participants. Narrower OBP ranges increased AUCs, peaking at OBP\u2009\u2265\u2009130\/80-&amp;lt;150\/90 mmHg (0.682 and 0.677 in untreated and treated, respectively). In the ABPM cohort, the corresponding values for OBP\u2009\u2265\u2009130\/80-&amp;lt;160\/100 mmHg were 94%, 34%, and 0.641 (untreated) and 91%, 41%, and 0.662 (treated), AUC\u2019s were highest at OBP \u2265130\/80-&amp;lt;150\/90 mmHg (0.722 in both groups).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This real-world analysis shows that OBP thresholds recommended by the 2025-AHA\/ACC-BP guideline for WCH\/WCE screening are highly sensitive but have low specificity, resulting in referral of the majority of patients for out-of-office BP assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajh\/hpag027","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T12:42:43Z","timestamp":1774356163000},"page":"966-969","source":"Crossref","is-referenced-by-count":1,"title":["The challenge of white-coat hypertension screening"],"prefix":"10.1093","volume":"39","author":[{"given":"Christian S","family":"Dal Pont","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, School of Medical Sciences, State University of Campinas , S\u00e3o Paulo, SP,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9719-3176","authenticated-orcid":false,"given":"Rodrigo","family":"Bezerra","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medical Sciences, State University of Campinas , S\u00e3o Paulo, SP,","place":["Brazil"]},{"name":"Pronto Socorro Cardiol\u00f3gico de Pernambuco (PROCAPE), University of Pernambuco , Recife, PE,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weimar S","family":"Barroso","sequence":"additional","affiliation":[{"name":"Hypertension League, Cardiovascular Section, Federal University of Goi\u00e1s , Goi\u00e2nia, GO,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco A","family":"Mota-Gomes","sequence":"additional","affiliation":[{"name":"Department of Medicine, CESMAC University Center\/Heart Hospital of Alagoas , Macei\u00f3, AL,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annelise M G","family":"Paiva","sequence":"additional","affiliation":[{"name":"Department of Medicine, CESMAC University Center\/Heart Hospital of Alagoas , Macei\u00f3, AL,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto D","family":"Miranda","sequence":"additional","affiliation":[{"name":"Cardiovascular Section, Geriatrics Division, Paulista School of Medicine, Federal University of S\u00e3o Paulo , S\u00e3o Paulo, SP,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo C D","family":"Barbosa","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Feevale University , Porto Alegre, RS,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9a A","family":"Brand\u00e3o","sequence":"additional","affiliation":[{"name":"School of Medical Sciences, State University of Rio de Janeiro , Rio de Janeiro, RJ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrei C","family":"Sposito","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medical Sciences, State University of Campinas , S\u00e3o Paulo, SP,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audes D M","family":"Feitosa","sequence":"additional","affiliation":[{"name":"Pronto Socorro Cardiol\u00f3gico de Pernambuco (PROCAPE), University of Pernambuco , Recife, PE,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilson","family":"Nadruz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medical Sciences, State University of Campinas , S\u00e3o Paulo, SP,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"2026071510284682800_hpag027-B1","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1016\/j.jacc.2025.05.007","article-title":"AHA\/ACC\/AANP\/AAPA\/ABC\/ACCP\/ACPM\/AGS\/AMA\/ASPC\/NMA\/PCNA\/SGIM guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American college of cardiology\/American heart association joint committee on clinical practice guidelines","volume":"86","author":"Jones","year":"2025","journal-title":"J Am Coll Cardiol"},{"key":"2026071510284682800_hpag027-B2","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1093\/eurjpc\/zwaf197","article-title":"Discrepancies between office and home blood pressure targets in patients with hypertension according to the 2024 european society of cardiology hypertension guidelines","volume":"32","author":"Bezerra","year":"2025","journal-title":"Eur J Prev Cardiol"},{"key":"2026071510284682800_hpag027-B3","doi-asserted-by":"crossref","first-page":"e20250624","DOI":"10.36660\/abc.20250624","article-title":"Brazilian guidelines of hypertension\u20142025","volume":"122","author":"Brand\u00e3o","year":"2025","journal-title":"Arq Bras Cardiol"},{"key":"2026071510284682800_hpag027-B4","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1038\/s41440-024-01973-4","article-title":"Relationship between white-coat hypertension and office isolated systolic or diastolic hypertension: an ambulatory blood pressure monitoring study","volume":"48","author":"Dal Pont","year":"2025","journal-title":"Hypertens Res."},{"key":"2026071510284682800_hpag027-B5","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1038\/s41371-024-00930-5","article-title":"Cutoffs for white-coat and masked blood pressure effects: an ambulatory blood pressure monitoring study","volume":"38","author":"Dal Pont","year":"2024","journal-title":"J Hum Hypertens"},{"key":"2026071510284682800_hpag027-B6","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1097\/HJH.0000000000002320","article-title":"Relationship between office isolated systolic or diastolic hypertension and white-coat hypertension across the age spectrum: a home blood pressure study","volume":"38","author":"Feitosa","year":"2020","journal-title":"J Hypertens"},{"key":"2026071510284682800_hpag027-B7","doi-asserted-by":"crossref","first-page":"e35","DOI":"10.1093\/eurjpc\/zwad387","article-title":"Impact of environmental temperature on blood pressure phenotypes: a nationwide home blood pressure monitoring study","volume":"31","author":"Barbosa","year":"2024","journal-title":"Eur J Prev Cardiol."},{"key":"2026071510284682800_hpag027-B8","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1097\/MBP.0b013e328339be38","article-title":"Evaluation of the Mobil-O-Graph new generation ABPM device using the ESH criteria","volume":"15","author":"Franssen","year":"2010","journal-title":"Blood Press Monit"}],"container-title":["American Journal of 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