Masked hypertension in the elderly: cross-sectional analysis of a population-based sample

Masked hypertension (MHT), defined as normal blood pressure (BP) at office associated with high BP at home, has been shown to be associated with an increased risk of vascular events. However, MHT is poorly known in the elderly, although this age segment is at high risk of hypertension-related vascular events. Our objectives were to assess frequency and determinants of MHT in the elderly.

We studied MHT in a community-based sample of 1,814 participants aged 75 years or older, whose office BP and home BP measurements (HBPM) were both taken with the same device (Omron M6; Omron Healthcare, Kyoto, Japan).Hypertension was defined as a systolic BP (SBP) ≥ 140 mm Hg and/or a diastolic BP (DBP) ≥ 90 mm Hg for office BP, and SBP ≥ 135 mm Hg and/or DBP ≥ 85 mm Hg for HBPM.

Frequency of MHT was 16% in the overall sample and 41% in participants with a normal office BP. Multivariable analyses revealed that male subjects, >80 years of age, with diabetes, on antihypertensive medication, and with office SBP >120 mm Hg were independently associated with a higher risk of MHT.

MHT is frequent in the elderly and is associated with a high vascular profile. These results should encourage a more widespread use of home BP monitoring in this age segment.