Masked hypertension: understanding its complexity

Area of Science:

• Cardiology
• Hypertension Research
• Diagnostic Medicine

Background:

• Masked hypertension, defined as normal in-office blood pressure (BP) with elevated out-of-office BP, is prevalent in untreated individuals and even more common in patients on antihypertensive medication.
• Individuals with prehypertension are at higher risk for masked hypertension and may experience target organ damage before developing sustained hypertension.
• This condition is particularly frequent in individuals of African descent, and in those with cardiovascular risk factors like diabetes and chronic renal failure.

Purpose of the Study:

• To highlight the prevalence and significance of masked hypertension.
• To identify risk factors and potential early markers for masked hypertension.
• To emphasize the diagnostic role of ambulatory blood pressure monitoring (ABPM) in managing masked hypertension.

Main Methods:

• Review of existing literature on masked hypertension.
• Analysis of prevalence data in different patient populations.
• Evaluation of diagnostic tools, particularly 24-hour ambulatory blood pressure monitoring (ABPM).

Main Results:

• Masked hypertension is surprisingly common in both untreated individuals and those receiving antihypertensive treatment.
• Prehypertension, African ancestry, diabetes, and chronic renal failure are associated with a higher incidence of masked hypertension.
• Nocturnal hypertension and non-dipping patterns may serve as early indicators.
• A significant proportion of treated masked hypertension patients have 'masked uncontrolled hypertension'.

Conclusions:

• Masked hypertension is an under-recognized condition requiring vigilant diagnosis.
• Twenty-four hour ambulatory BP monitoring (ABPM) is the gold standard for diagnosing masked hypertension.
• Effective management necessitates ABPM and potentially home BP monitoring to ensure adequate BP control.