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Prognostic relevance of masked hypertension in subjects with prehypertension

Sante D Pierdomenico1, Giuseppe Pannarale, Franco Rabbia

  • 1Dipartimento di Medicina e Scienze dell'Invecchiamento, University G. d'Annunzio, Chieti, Italy. pierdomenico@unich.it

American Journal of Hypertension
|May 10, 2008
PubMed

Insights

Masked hypertension in prehypertension patients significantly increases cardiovascular risk compared to true prehypertension. Ambulatory blood pressure monitoring is recommended for better risk assessment.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Preventive Medicine

Background:

  • The prognostic significance of masked hypertension remains unclear.
  • Masked hypertension, normal clinic blood pressure with elevated out-of-office readings, poses a diagnostic challenge.
  • Prehypertension is a critical stage for cardiovascular risk stratification.

Purpose of the Study:

  • To investigate the prognostic value of masked hypertension in individuals with prehypertension.
  • To compare cardiovascular event rates between true prehypertension and masked hypertension groups.
  • To determine if masked hypertension independently predicts cardiovascular risk.

Main Methods:

  • Prospective evaluation of 591 prehypertension subjects (clinic BP 120-139/80-89 mm Hg).
  • Classification into true prehypertension (clinic BP <140/90, daytime BP <135/85 mm Hg) and masked hypertension (clinic BP <140/90, daytime BP ≥135/85 mm Hg).
  • Follow-up for fatal and nonfatal cardiovascular events over 6.6 years, analyzed using Cox regression.

Main Results:

  • Masked hypertension subjects had a higher event rate (1.51 per 100 patient-years) versus true prehypertension (0.57 per 100 patient-years).
  • Event-free survival significantly differed between groups (P < 0.005).
  • Adjusted Cox analysis revealed a 2.65-fold higher cardiovascular risk in masked hypertension (95% CI 1.18-5.98, P = 0.018).

Conclusions:

  • Individuals with prehypertension and masked hypertension face significantly elevated cardiovascular risk.
  • Out-of-office blood pressure measurement, such as ambulatory BP monitoring, is crucial for accurate risk stratification in prehypertension.
  • Identifying masked hypertension allows for timely intervention to mitigate cardiovascular events.
Abstract

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