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Recognition and management of masked hypertension: a review and novel approach

Yuichiro Yano1, George L Bakris

  • 1American Society of Hypertension Comprehensive Hypertension Center, Department of Medicine, The University of Chicago Medicine, Chicago, Illinois 60637, USA.

Journal of the American Society of Hypertension : JASH
|March 26, 2013
PubMed

Insights

Masked hypertension, where blood pressure is high outside the doctor's office, may explain why some treatments fail. Monitoring blood pressure at home or with ambulatory devices is key for better risk assessment and management.

Area of Science:

  • Cardiology
  • Nephrology
  • Hypertension Research

Background:

  • Some cardiovascular and renal outcome trials have failed to demonstrate treatment benefits.
  • Masked hypertension, defined as blood pressure in the hypertensive range outside the office setting, is a potential confounding factor.
  • This condition is linked to increased cardiovascular morbidity and mortality.

Purpose of the Study:

  • To review the clinical impact of masked hypertension on cardiovascular risk.
  • To examine the effect of masked hypertension on the progression of kidney disease.
  • To propose a clinical management paradigm for masked hypertension.

Main Methods:

  • Literature review focusing on cardiovascular and renal outcomes in relation to masked hypertension.
  • Analysis of the role of ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM).
  • Evaluation of treatment strategies for masked hypertension.

Main Results:

  • Ambulatory blood pressure monitoring and home blood pressure monitoring are superior to office blood pressure for assessing target-organ damage and predicting cardiovascular events.
  • Masked hypertension is associated with an increased risk of developing primary hypertension.
  • Effective management may involve short-acting medications or addressing underlying causes.

Conclusions:

  • Masked hypertension significantly impacts cardiovascular risk and kidney disease progression.
  • ABPM and HBPM are crucial for accurate diagnosis and risk stratification.
  • A validated clinical management paradigm for masked hypertension is needed.

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