In contrast to white coat hypertension, masked hyperten- sion is associated with a CVD and all-cause mortality risk twice as high as that seen in normotensive individuals, with a risk range similar to that of patients with sustained Therefore, out- of-office readings are reasonable to confirm BP control seen with office readings. 5. The white coat effect has been implicated in office- measured uncontrolled hypertension and pseudo- resistant hypertension, which may result in BP control being underestimated when subsequently assessed by The risk of vascular complications in patients with office-measured uncontrolled hyperten- sion with a white coat effect is similar to the risk in those with controlled hypertension.S4.4-3,S4.4-4,S4.4-7,S4.4-11,S4.4-12 White coat hypertension and white coat effect raise the concern that unnecessary antihypertensive drug therapy may be initiated or intensified. Because a diagnosis of white coat hypertension or white coat effect would result in a deci- sion to not treat elevated office BP readings, confirmation of BP control by HBPM (or ABPM) provides more de- finitive support for the decision not to initiate antihyper- tensive drug therapy or accelerate treatment. 6. Analogous to masked hypertension in untreated patients, masked uncontrolled hypertension is defined in treated pa- tients with hypertension by office readings suggesting ad- equate BP control but out-of-office readings (HBPM) that remain consistently above goal.S4.4-3,S4.4-15,S4.4-16,S4.4-32,S4.4-33 The CVD risk profile for masked uncontrolled hyper- tension appears to follow the risk profile for masked Although the evidence is consistent in identifying the increased risk of masked uncontrolled hypertension, evidence is lacking on whether the treatment of masked hypertension or masked uncontrolled hypertension reduces clinical outcomes. A suggestion for assessing CVD risk is pro- vided in Section 8. 7. 