The complexity of masked hypertension: diagnostic and management challenges

Area of Science:

• Cardiology
• Hypertension Research
• Clinical Diagnostics

Background:

• Masked hypertension, characterized by normal in-office blood pressure and elevated out-of-office readings, affects 10-40% of untreated patients.
• Individuals with prehypertension are at higher risk, often experiencing target organ damage before sustained hypertension develops.
• The prevalence of masked hypertension escalates with comorbidities like cardiovascular disease, diabetes, and chronic kidney disease.

Purpose of the Study:

• To highlight the prevalence and risks associated with masked hypertension.
• To emphasize the diagnostic utility of ambulatory and home blood pressure monitoring.
• To underscore the importance of out-of-office monitoring for effective hypertension management.

Main Methods:

• Review of literature on masked hypertension diagnosis and management.
• Comparison of in-office blood pressure monitoring with 24-hour ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM).

Main Results:

• Masked hypertension is prevalent, particularly in patients with prehypertension and comorbidities.
• 24-hour ambulatory BP monitoring (ABPM) is the gold standard for diagnosis, with home BP monitoring (HBPM) serving as a valuable alternative.
• Relying solely on in-office readings can lead to undertreatment in nearly one-third of patients with masked uncontrolled hypertension.

Conclusions:

• Masked hypertension poses a significant risk, often preceding sustained hypertension and associated with target organ damage.
• Ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) are essential tools for accurate diagnosis.
• Integrating out-of-office BP monitoring into clinical practice is vital for optimal hypertension control and preventing adverse outcomes.