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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

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Summary

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.

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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.