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Published on: August 14, 2013
Masked hypertension: a review
Thomas G Pickering1, Kazuo Eguchi, Kazuomi Kario
1Center for Behavioral Cardiovascular Health, Division of General Medicine, Columbia University Medical Center, New York 10032, USA. tp2114@columbia.edu
Insights
Masked hypertension, normal in-office blood pressure but high out-of-office, affects 10% of people. This condition increases cardiovascular risks and requires further investigation beyond routine checks.
Area of Science:
- Cardiology
- Hypertension Research
- Preventive Medicine
Background:
- Masked hypertension (MH) is characterized by normal clinic blood pressure (BP) but elevated out-of-clinic BP readings.
- MH affects up to 10% of the general population and is associated with adverse cardiovascular outcomes.
- It often goes undiagnosed through routine medical examinations, despite its significant health implications.
Purpose of the Study:
- To define masked hypertension and highlight its diagnostic challenges.
- To discuss the potential characteristics and risk factors associated with MH.
- To emphasize the importance of out-of-clinic BP monitoring for early detection and management.
Main Methods:
- Review of existing literature and clinical definitions of masked hypertension.
- Identification of demographic, lifestyle, and clinical factors associated with MH.
- Discussion of diagnostic approaches and implications for patient management.
Main Results:
- Masked hypertension is defined as clinic BP <140/90 mmHg and out-of-clinic BP >135/85 mmHg.
- Associated factors include younger age, male sex, stress, physical activity, smoking, and alcohol consumption.
- MH has been observed in treated hypertensive patients and children, indicating broader clinical relevance.
Conclusions:
- Masked hypertension poses a significant risk for target organ damage and cardiovascular events.
- Individuals with a history of occasional high BP readings but normal clinic BP should be monitored closely.
- Encouraging out-of-clinic BP monitoring, especially for smokers and those in the prehypertensive range, is crucial for early detection.
Abstract:
Masked hypertension is defined as a normal blood pressure (BP) in the clinic or office (<140/90 mmHg), but an elevated BP out of the clinic (ambulatory daytime BP or home BP>135/85 mmHg). It may occur in as many as 10% of the general population, and is important because it is not diagnosed by routine medical examinations, but carries an adverse prognosis, both in terms of increased target organ damage and cardiovascular events. Possible characteristics of individuals with masked hypertension are: relatively young age, male sex, stress or increased physical activity during the daytime, and smoking or drinking habits. Masked hypertension has also been described in treated hypertensive patients (in whom the prognosis is worse than predicted from the clinic pressure) and in children, in whom it may be a precursor of sustained hypertension. It may be suspected in individuals who have a history of occasional high BP readings, but who are apparently normotensive when checked in the office. One practical point is that we should continue to follow such people rather than dismissing them, and encourage out-of-clinic monitoring of BP. This would apply particularly to smokers and those with BP in the prehypertensive range. The potential implications of masked hypertension are huge, but the optimal strategy for detecting the condition in the general population is not yet clear.
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