PREVALENCE OF MASKED UNCONTROLLED HYPERTENSION IN TREATED HYPERTENSIVE PATIENTS

Abstract

Objective: There are limited data in Tunisia on the quality of treated blood pressure (BP) control, and in particular, masked uncontrolled hypertension (MUCH) in treated hypertensive patients defined as controlled office BP but uncontrolled out-of-clinic BP. The objective of the study is to define the prevalence of MUCH in treated hypertensive patients. Design and method: An analytical cross-sectional study including 84 treated hypertensive patients aged > 18 years, followed at the outpatient cardiology clinic of the Mohamed Taher Maamouri university hospital in Nabeul over a six months period (July-December 2021). The BP measurement in the office was performed on the day of inclusion. Patients were asked to measure BP at home as instructed by the physician using validated blood pressure self-measurement devices ( MICROLIFE BP A3 PLUS, MICROLIFE BP A2 Basic and Beurer BM 40 ). These devices were loaned to the patient who had to return them on the day of the ABPM installation. Laying of ABPM was performed immediately after the HBPM using a Bravo Mini validated device from Sun Tech Medical. The comparisons of percentages were carried out by the Chi-square test. Results: The mean age of our population was 59.37±13.10 years (range 21-92 years), composed of 43 women and 41 men. The prevalence of MUCH was 6% in HBPM and 8.3% in ABPM. The difference between these two methods was not statistically significant for the detection of masked uncontrolled hypertension (p = 0.320). The prevalence of MUCH was higher in women detected by HBPM (11.6% versus 0%; p = 0.055) and by ABPM (14% versus 2.4%; p = 0.110), the difference according to gender was not statistically significant. ABPM detected also masked uncontrolled nocturnal hypertension in 14.3% of cases. Conclusions: Office BP monitoring alone is thus inadequate to ascertain optimal BP control because of BP variation. HBPM and mainly ABPM which can detect elevated nocturnal BP were needed to confirm proper BP control especially in patients with high cardiovascular risk in whom the prevalence of MUCH is higher.