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Published on: August 14, 2013
Masked hypertension definition, impact, outcomes: a critical review
Dimitris P Papadopoulos1, Thomas K Makris
1Hypertension Clinic, Cardiology Department, Laiko Hospital, Athens, Greece. jimpapdoc@yahoo.com
Insights
Masked hypertension (MH), where out-of-office blood pressure is high but office readings are normal, affects 1 in 7-8 people. This condition increases cardiovascular risk, necessitating out-of-office BP monitoring.
Area of Science:
- Cardiology
- Hypertension Research
- Preventive Medicine
Background:
- Masked hypertension (MH) is characterized by normal office blood pressure (<140/90 mm Hg) but elevated out-of-office readings.
- MH affects approximately 1 in 7 to 8 individuals with seemingly normal or controlled office blood pressure.
- Its prevalence is comparable to isolated office hypertension, highlighting a significant unmet clinical need.
Purpose of the Study:
- To define masked hypertension (MH).
- To describe the prevalence of MH in the general population.
- To explore the association between MH and cardiovascular events.
Main Methods:
- Literature review of studies defining MH and its prevalence.
- Analysis of factors influencing MH, including stress and lifestyle.
- Examination of outcome studies correlating MH with cardiovascular complications.
Main Results:
- Individuals with MH exhibit increased prevalence of organ damage, including metabolic risk factors, left ventricular mass, and carotid intima-media thickness.
- MH is associated with a cardiovascular risk comparable to sustained office and out-of-office hypertension.
- Behavioral factors like smoking, alcohol, and sedentary habits can influence MH development.
Conclusions:
- The high prevalence of MH underscores the importance of out-of-office blood pressure measurement.
- MH is a significant risk factor for cardiovascular complications, similar to sustained hypertension.
- Screening for MH is crucial in individuals at high risk for cardiovascular disease, such as those with kidney disease or diabetes.
Abstract:
The phenomenon of masked hypertension (MH) is defined as a clinical condition in which a patient's office blood pressure (BP) level is <140/90 mm Hg but ambulatory or home BP readings are in the hypertensive range. The prevalence in the population is about the same as that of isolated office hypertension; about 1 in 7 or 8 persons with a normal office BP level may fall into this category. The high prevalence of MH would suggest the necessity for measuring out-of-office BP in persons with apparently normal or well-controlled office BP. Reactivity to daily life stressors and behavioral factors such as smoking, alcohol use, contraceptive use in women, and sedentary habits can selectively influence MH. MH should be searched for in individuals who are at increased risk for cardiovascular complications including patients with kidney disease or diabetes. Individuals with MH have been shown to have a greater-than-normal prevalence of organ damage, particularly with an increased prevalence of metabolic risk factors, left ventricular mass index, carotid intima-media thickness, and impaired large artery distensibility compared with patients with a truly normal BP level in and out of the clinic or office. Also, outcome studies have suggested that MH increases cardiovascular risk, which appears to be close to that of in-office and out-of-office hypertension. The aim of this review was to define the entity of MH, to describe its prevalence in the general population, and to discuss its correlation with cardiovascular events.
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