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Clinical features and predictors of masked uncontrolled hypertension from the Korean Ambulatory Blood Pressure
Hyun-Jin Kim1, Jeong-Hun Shin1, Yonggu Lee1
1Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
Insights
Masked uncontrolled hypertension (MUCH) is linked to worse metabolic health and fewer medications. A new model accurately predicts MUCH using factors like high office BP, stroke history, and left ventricular hypertrophy.
Area of Science:
- Cardiology
- Hypertension Management
- Clinical Prediction Models
Background:
- Masked uncontrolled hypertension (MUCH) characteristics and predictors are poorly understood.
- Limited research exists on identifying patients with MUCH despite normal office blood pressure (BP).
Purpose of the Study:
- To define the clinical characteristics of patients with MUCH.
- To identify predictors of MUCH.
- To develop a prediction model for MUCH in hypertensive patients.
Main Methods:
- Analysis of 1,986 patients from the Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) Registry on antihypertensive drugs.
- Classification into controlled hypertension (n=465) and MUCH (n=389) groups based on 24-hour ambulatory BP.
- MUCH defined as 24-hour ambulatory mean BP ≥ 130/80 mmHg with normal office BP.
Main Results:
- MUCH patients had poorer metabolic profiles and higher office BP than controlled hypertension patients.
- Independent predictors of MUCH included high office BP, prior stroke, dyslipidemia, left ventricular hypertrophy (LVH), high heart rate, and single antihypertensive drug use.
- The developed prediction model demonstrated high diagnostic accuracy (C-index=0.839) and good fit.
Conclusions:
- MUCH is associated with high-normal office BP, underuse of antihypertensive drugs, dyslipidemia, prior stroke, and LVH.
- These factors highlight challenges in achieving optimal BP control.
- The proposed model effectively predicts MUCH in patients with controlled office BP.
Background/Aims:
The clinical characteristics of patients with masked uncontrolled hypertension (MUCH) have been poorly defined, and few studies have investigated the clinical predictors of MUCH. We investigated the demographic, clinical, and blood pressure (BP) characteristics of patients with MUCH and proposed a prediction model for MUCH in patients with hypertension.
Methods:
We analyzed 1,986 subjects who were enrolled in the Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) Registry and taking antihypertensive drugs, and classified them into the controlled hypertension (n = 465) and MUCH (n = 389) groups. MUCH was defined as the presence of a 24-hour ambulatory mean systolic BP ≥ 130 mmHg and/or diastolic BP ≥ 80 mmHg in patients treated with antihypertensive drugs, having normal office BP.
Results:
Patients in the MUCH group had significantly worse metabolic profiles and higher office BP, and took significantly fewer antihypertensive drugs compared to those in the controlled hypertension group. Multivariate logistic regression analyses identified high office systolic BP and diastolic BP, prior stroke, dyslipidemia, left ventricular hypertrophy (LVH, ≥ 116 g/m2 for men, and ≥ 96 g/m2 for women), high heart rate (≥ 75 beats/min), and single antihypertensive drug use as independent predictors of MUCH. A prediction model using these predictors showed a high diagnostic accuracy (C-index of 0.839) and goodness-of-fit for the presence of MUCH.
Conclusion:
MUCH is associated with a high-normal increase in office BP and underuse of antihypertensive drugs, as well as dyslipidemia, prior stroke, and LVH, which could underscore achieving optimal BP control. The proposed model accurately predicts MUCH in patients with controlled office BP.
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