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Masked Nocturnal Hypertension and Hidden Organ Risk: A Systematic Review
Anas M Berro1, Mostafa M Obeid Alla2, Mohamed Madani3,4
1Medicine, Faculty of Medicine, Beirut Arab University, Beirut, LBN.
Cureus
|July 26, 2026
Summary
Masked nocturnal hypertension, where nighttime blood pressure is high despite normal daytime readings, is linked to increased cardiovascular and organ damage risks. Ambulatory blood pressure monitoring can improve risk assessment, especially in high-risk patients.
Area of Science:
- Cardiology
- Nephrology
- Hypertension Research
Background:
- Masked nocturnal hypertension (MNH) is characterized by normal office blood pressure (BP) and elevated nighttime ambulatory BP.
- This hidden phenotype may be associated with adverse cardiovascular and target-organ outcomes.
- 24-hour ambulatory blood pressure monitoring (ABPM) is crucial for detecting MNH.
Purpose of the Study:
- To systematically review the association between MNH or isolated nocturnal hypertension (INH) and cardiovascular or target-organ outcomes.
- To evaluate the clinical significance of MNH in adults with normal or controlled office BP.
- To assess the utility of ABPM in risk stratification.
Main Methods:
- Systematic literature search across major databases (PubMed, WOS, Scopus, Cochrane).
- Inclusion of studies on adults with normal/controlled office BP and ABPM data, reporting cardiovascular outcomes or target-organ damage.
- Exclusion of reviews, pediatric, pregnancy, and incomplete data studies; risk-of-bias assessment performed.
Main Results:
- MNH and INH were generally associated with increased risks of cardiovascular events, stroke, and mortality.
- Significant associations found with renal, cardiac, vascular, and cerebrovascular target-organ damage.
- Damage indicators included renal impairment, albuminuria, left ventricular hypertrophy, arterial stiffness, and silent cerebrovascular lesions.
Conclusions:
- MNH is a clinically significant phenotype in adults with seemingly controlled BP.
- ABPM is valuable for identifying MNH and enhancing cardiovascular and target-organ risk stratification.
- Nighttime BP assessment is particularly important for high-risk populations like those with CKD, diabetes, or treated hypertension.
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