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Published on: February 10, 2016
Masked uncontrolled hypertension: Prevalence and predictors
Ghada Youssef1, Sherif Nagy1, Ahmed El-Gengehe1
1Cairo University, Cairo, Egypt.
Insights
Masked uncontrolled hypertension (MUCH) affects one-third of patients with seemingly controlled blood pressure. Nocturnal blood pressure is often the cause, highlighting the need for ambulatory blood pressure monitoring (ABPM) in high-risk individuals.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Trials
Background:
- Limited data exists on masked uncontrolled hypertension (MUCH) in patients with treated and apparently well-controlled blood pressure.
- Understanding MUCH is crucial for effective hypertension management and cardiovascular risk reduction.
Purpose of the Study:
- To determine the prevalence of MUCH among hypertensive patients with controlled office blood pressure.
- To identify predictors associated with MUCH in this patient population.
Main Methods:
- 199 hypertensive patients with controlled office blood pressure (<140/90 mmHg) were enrolled.
- Ambulatory blood pressure monitoring (ABPM) was performed for 24 hours within a week of the clinic visit.
- MUCH was defined as elevated average 24-hour ABPM (≥130/80 mmHg) despite controlled clinic BP.
Main Results:
- The prevalence of MUCH was 33.2% (66 out of 199 patients).
- Elevated nocturnal blood pressure was the primary contributor to MUCH (57.3%), more so than daytime elevation (27.1%).
- Key predictors identified for MUCH included smoking, diabetes mellitus (DM), and a positive family history of DM.
Conclusions:
- Masked suboptimal blood pressure control is prevalent, indicating office BP monitoring alone is insufficient.
- Ambulatory blood pressure monitoring (ABPM) is essential for confirming optimal BP control, particularly in patients with a high cardiovascular risk profile.
- Smoking, diabetes mellitus, and a family history of diabetes are significant predictors of MUCH.
Background:
There are limited data on 'masked uncontrolled hypertension' (MUCH) in patients with treated and apparently well-controlled BP is unknown.
Objectives:
To define the prevalence and predictors of MUCH among hypertensive patients with controlled office blood pressure.
Methods:
One hundred ninety-nine hypertensive patients presented to the specialized hypertension clinics at two University Hospitals. All patients had controlled office blood pressure (less than 140/90 mmHg). Patients were assessed regarding history, clinical examination, and laboratory data. All patients underwent ambulatory blood pressure monitoring (ABPM) for 24 h, within a week after the index office visit. MUCH was diagnosed if average 24-h ABPM was elevated (systolic BP ≥ 130 mmHg and/or diastolic BP ≥ 80 mmHg) despite controlled clinic BP.
Results:
Sixty-six patients (33.2%) had MUCH according to 24-h ABPM criteria (mean age 53.5 ± 9.3 years, 60.6% men). MUCH was mostly caused by the poor control of nocturnal BP; with the percentage of patients in whom MUCH was solely attributable to an elevated nocturnal BP almost double that due to daytime BP elevation (57.3% vs. 27.1%, P < 0.001). The most common predictors of MUCH were smoking, DM and positive family history of DM.
Conclusion:
The prevalence of masked suboptimal BP control is high. Office BP monitoring alone is thus inadequate to ascertain optimal BP control because many patients have an elevated nocturnal BP. ABPM is needed to confirm proper BP control, especially in patients with high cardiovascular risk profile. Smoking, DM and positive family history of DM were the most common predictors of MUCH.
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