Prognostic Value of Masked Uncontrolled Hypertension Defined by Different Ambulatory Blood Pressure Criteria

Area of Science:

• Cardiology
• Hypertension Research
• Ambulatory Blood Pressure Monitoring

Background:

• Masked uncontrolled hypertension (MUCH), characterized by normal clinic blood pressure (BP) but elevated out-of-office BP, poses a higher cardiovascular risk than controlled hypertension (CH).
• Ambulatory BP monitoring (ABPM) is crucial for diagnosing MUCH, with definitions varying based on daytime, nighttime, or 24-hour BP thresholds.
• The prognostic implications of these diverse ABPM-based MUCH definitions remain unclear.

Purpose of the Study:

• To evaluate the prognostic value of different ambulatory BP criteria for defining masked uncontrolled hypertension (MUCH).
• To compare the cardiovascular event risk associated with various definitions of MUCH in treated hypertensive patients.

Main Methods:

• A cohort of 738 treated hypertensive patients with nonhypertensive clinic BP was analyzed.
• Patients were categorized into controlled hypertension (CH) or various MUCH groups based on daytime, nighttime, or 24-hour ambulatory BP thresholds.
• Cardiovascular events were tracked over a mean follow-up of 10 years, with adjusted hazard ratios calculated.

Main Results:

• Significant proportions of patients met criteria for MUCH across different definitions (ranging from 5.5% to 48.5%).
• Compared to CH, adjusted hazard ratios for cardiovascular events in MUCH groups ranged from 1.15 to 2.29.
• Specific definitions, such as daytime + nighttime MUCH (Group 6), showed a significantly elevated risk (HR 2.29).

Conclusions:

• The definition of masked uncontrolled hypertension (MUCH) based on ambulatory BP criteria significantly influences its prognostic impact.
• Different ABPM criteria for MUCH may carry distinct cardiovascular risks in treated hypertensive individuals.
• Further research is needed to standardize MUCH definitions for accurate risk stratification.