Prevalence Of Masked Hypertension Research Articles

Masked Hypertension Definition, Impact, Outcomes: A Critical Review

The phenomenon of masked hypertension (MH) is defined as a clinical condition in which a patient's office blood pressure (BP) level is <140/90 mm Hg but ambulatory or home BP readings are in the hypertensive range. The prevalence in the population is about the same as that of isolated office hypertension; about 1 in 7 or 8 persons with a normal office BP level may fall into this category. The high prevalence of MH would suggest the necessity for measuring out-of-office BP in persons with apparently normal or well-controlled office BP. Reactivity to daily life stressors and behavioral factors such as smoking, alcohol use, contraceptive use in women, and sedentary habits can selectively influence MH. MH should be searched for in individuals who are at increased risk for cardiovascular complications including patients with kidney disease or diabetes. Individuals with MH have been shown to have a greater-than-normal prevalence of organ damage, particularly with an increased prevalence of metabolic risk factors, left ventricular mass index, carotid intima-media thickness, and impaired large artery distensibility compared with patients with a truly normal BP level in and out of the clinic or office. Also, outcome studies have suggested that MH increases cardiovascular risk, which appears to be close to that of in-office and out-of-office hypertension. The aim of this review was to define the entity of MH, to describe its prevalence in the general population, and to discuss its correlation with cardiovascular events.

Prevalence and Persistence of Masked Hypertension in Treated Hypertensive Patients

Masked hypertension (MH) is defined as a normal blood pressure in the physician's office and an elevated blood pressure when measured out-of-office. The cause of MH may be termed the masked hypertension effect (MHE), and is not restricted to blood-pressure (BP) values around the thresholds for normal BP. We investigated the prevalence and persistence of MH and MHE in patients who were being treated for high BP and who had been followed for a period of 1 year. One hundred and sixty-one treated hypertensive patients underwent office blood-pressure measurements (OBPMs) at seven visits and self-performed blood-pressure measurements (SBPMs) for 1 week before each visit over a period of 1 year. All measurements were performed with the same type of automatic device. At each visit, MH was determined according to the European Society of Hypertension definition (OBPM, <140/90 mm Hg; SBPM, >/=135 mm Hg or 85 mm Hg). In addition, we determined prevalences of MHE at 5/3 mm Hg (SBPM exceeds OBPM by 5 mm Hg systolic and 3 mm Hg diastolic), and MHE at 10/6 mm Hg (SBPM exceeds OBPM by 10 mm Hg systolic and 6 mm Hg diastolic), respectively. During the entire study, 50% of the patients had MH, and 40% had MHE at 5/3 mm Hg at least once. At four sequential OBPM visits, 2% consistently had MH, and 3% had MHE at 5/3 mm Hg or MHE at 10/6 mm Hg. The prevalence of MH increased with lower OBPM levels but remained rather constant for MHE at 5/3 mm Hg and MHE at 10/6 mm Hg. The persistence of MH and the MHE over time in individual patients was low. We conclude that MH and MHE at 5/3 mm Hg and MHE at 10/6 mm Hg commonly occur in treated patients, but are not persistent phenomena and probably result from an accidentally low OBPM value on one particular occasion.

Masked Hypertension in Diabetes Mellitus: A Potential Risk

The prevalence and clinical significance of masked hypertension (MHT) in diabetics have infrequently been described. The authors assessed the association of MHT (defined using a clinic blood pressure [BP] <140/90 mm Hg and daytime ambulatory BP > or = 135/85 mm Hg) with microvascular and macrovascular end organ damage in 81 clinically normotensive Japanese diabetic persons. The prevalence of silent cerebral infarcts (SCIs), increased left ventricular mass, and albuminuria were evaluated. Of 81 patients, 38 (46.9%) were classified as having MHT and showed significantly more SCIs (mean +/- SE: 2.5+/-0.5 vs 1.1+/-0.2; P=.017), and more albuminuria (39% vs 16%; P=.025), but no increase in left ventricular mass index, than the normotensive persons in office and on ambulatory BP monitoring group. The prevalence of MHT in this diabetic population was high (47%). Diabetic patients with MHT showed evidence of brain and kidney damage. Hence, out-of-office monitoring of BP may be indicated in diabetics whose BP is normal in the clinic.

Masked Hypertension, Urinary Albumin Excretion Rate, and Echocardiographic Parameters in Putatively Normotensive Type 2 Diabetic Patients

To evaluate the impact of masked hypertension in normotensive type 2 diabetic patients on microvascular complications and echocardiographic parameters. A cross-sectional study was conducted in 135 normotensive patients with type 2 diabetes. Patients underwent urinary albumin excretion rate (UAER) measurement, echocardiography, and 24-h ambulatory blood pressure monitoring (ABPM). Patients with increased daytime blood pressure levels (> or = 135/85 mmHg) were classified as having masked hypertension. The prevalence of masked hypertension was 30% (n = 41). Normotensive and masked hypertensive subjects, based on ambulatory blood pressure, were not different in terms of age, diabetes duration, smoking status, BMI, waist circumference, serum creatinine, glycemic, or lipid profiles. The office systolic blood pressure was higher in those with masked hypertension (127.8 +/- 7.5 vs. 122.9 +/- 10.2 mmHg, P = 0.003) than in the normotensive group. UAER also was increased in the group with masked hypertension (21.3 microg/min [range 2.5-1,223.5] vs. 8.1 microg/min [1.0-1,143.0], P = 0.001), as was the interventricular septum (1.01 +/- 0.15 vs. 0.94 +/- 0.13 cm, P = 0.015) and posterior wall (0.96 +/- 0.12 vs. 0.90 +/- 0.10 cm, P = 0.006) thickness. After adjustments for diabetes duration, sex, smoking, LDL cholesterol, and A1C values, all associations were sustained for daytime systolic blood pressure but not for office systolic blood pressure. Type 2 diabetic patients with masked hypertension have higher UAER as well as enlargement of ventricular walls compared with the normotensive patients, according to ABPM. Therefore, ABPM is important to identify this high-risk group so as to be able to take interventionist measures.

Predictive factors for masked hypertension within a population of controlled hypertensives

Prevalence of masked hypertension (MH) is far from negligible reaching 40% in some studies. The SHEAF study (Self measurement of blood pressure at Home in the Elderly: Assessment and Follow-Up) and others clearly showed that masked hypertension (MH) as detected by home blood pressure measurement (HBPM) is associated with poor cardiovascular prognosis. Systematic HBPM to detect MH is not yet routine. The aim of this work is to better define the clinical profile of masked hypertensives within a population with controlled office blood pressure (BP) and the factors associated with a higher prevalence of MH. BP was measured at the clinic by the doctor and at home by the patient himself. Risk factors for MH were analysed in a cohort of 1150 treated hypertensive patients over the age of 60 (mean age 70 +/- 6.5, 48.9% men) with controlled office BP. (SBP < 140 mmHg and DBP < 90 mmHg). 463 patients (40%) were masked hypertensives (SBP > or = 135 mmHg or DBP > or = 85 mmHg at home). Three parameters were associated with MH (odds ratio OR): office SBP (OR = 1.110), male gender (OR = 2.214) and age (OR = 1.031). Decision trees showed a 130 mmHg SBP was an efficient threshold to propose HBPM with a higher probability to detect MH. Subsequent variables were male gender and age over 70 in males. To detect masked hypertension, it would be logical to first of all select patients whose office SBP is between 130 and 140 mmHg.

Influence of age and sex on prevalence of masked hypertension determined from home blood pressure measurements

Influence of age and sex on prevalence of masked hypertension determined from home blood pressure measurements

Prevalencia de la hipertensión de bata blanca e hipertensión enmascarada en la población general, mediante automedición domiciliaria de la presión arterial

To determine the prevalence of white-coat hypertension (WCH) and masked hypertension (MH) in the general population, by means of home blood pressure measurement (HBPM).Cross-sectional, descriptive study.Four primary care centres.A sample of 1400 individuals over 18 years old, selected from the Municipal Register of Inhabitants (Huelva, Spain) and randomised and stratified by age and gender.Two blood pressure (BP) measurements in clinic (CBP) and 12 measurements in a week of BP by HBPM were performed (OMRON 705-CP). Pressure was seen as normal when CBP means were <140/90 mm Hg and HBPM was <135/85 mm Hg. WCH was defined as when CBP was >140/90 mm Hg and HBPM <135/85 mm Hg, and hypertension when CBP was >140 mm Hg and HBPM >135/85 mm Hg or patients were in treatment for hypertension. MH was when CBP was <140/90 mm Hg and at home was >135 mm Hg and/or 85 mm Hg.A total of 1153 individuals (82.35% of the sample) with mean age of 45.4 (SD, 16.1) were included: 560 men and 593 women. The prevalence of MH was 8.9% (CI+/-1.6) in the general population and 9.8% (CI+/-3.2) in individuals with hypertension. WCH prevalence was 3.6% (CI+/-1.05) overall and 12.8% (CI+/-3.6) in hypertense patients, with its prevalence increasing steadily as age groups rose (P = .001).The prevalence of WCH in the general population is low, whereas the prevalence of MH is high.

Masked hypertension: A common but insidious presentation of hypertension

A patient has masked hypertension when his office blood pressure is less than 140/90 mmHg but his ambulatory or home blood pressure readings are in the hypertensive range. Several recent studies have demonstrated that cardiovascular risk is similar between those with masked hypertension and those with sustained hypertension. The prevalence of masked hypertension in Canada is not known, but data from other countries suggest rates greater than 8%. Physicians need to use careful clinical judgment to identify and treat subjects with masked hypertension. The present review discusses masked hypertension, its importance to clinical practice and some aspects of patient management.

Is masked hypertension an artefact due to the blood pressure measurement method and threshold effects? What is the true prevalence of masked hypertension?

Poncelet, Pascala; Clerson, Pierreb; Ribstein, Jeanc; Bassous, Marianned; Gres, Catherine Scartd Author Information

Masked hypertension: how can the condition be detected?

Recent evidence demonstrates that masked hypertension is a significant predictor of cardiovascular disease, but the problem for clinical practice is how to identify these patients. Furthermore, the prevalence of masked hypertension in the general population or in subjects with transient blood pressure elevation is still unknown. Data obtained in several cross-sectional studies have demonstrated large differences in the prevalence of masked hypertension, with prevalence rates from a low of 8% to a high of 49%. Two population-based studies performed in Italy and in Japan report prevalence of 9% and of 13.4%, respectively. A 49% frequency of masked hypertension has been found among subjects with transiently elevated clinic blood pressure. Several factors can selectively raise ambulatory blood pressure including age, sex, smoking, alcohol use, contraceptive use in women, and sedentary habits. Reactivity to daily life stressors and behavioural factors are other important determinants of ambulatory blood pressure. On the basis of the available evidence, masked hypertension should be searched for in individuals who are more likely to have this condition or are at increased risk of cardiovascular complications including diabetic individuals and subjects with kidney disease. Further research is needed to determine whether the use of ambulatory blood pressure monitoring is cost-effective in these subjects.

Detection of masked hypertension by home blood pressure measurement: is the number of measurements an important issue?

Office blood pressure (OBP) and home blood pressure (HBP) enable the identification of patients with masked hypertension. Masked hypertension is defined by normal OBP and high HBP and is known as a pejorative cardiovascular risk factor. The objective was to evaluate in the SHEAF study the influence of the number of office or home blood pressure measurements on the classification of patients as masked hypertensives. Patients with OBP <140/90 mmHg (mean of six values: three measurements at two separate visits, V1 and V2) and HBP >135/85 mmHg (mean of all valid measurements performed over a 4-day period) were the masked hypertensive reference group. The consistency of the classification was evaluated by using five definitions of HBP values (mean of the 3, 6, 9, 12 and 15 first measurements) and two definitions of OBP values (mean of three measurements at V1 and mean of three measurements at V2). Among the 4939 treated hypertensives included in the SHEAF study, 463 (9.4%) were classified as masked hypertensives (reference group). By decreasing the number of office or home measurements, the prevalence of masked hypertension ranged from 8.9-12.1%. The sensitivity of the classification ranged from 94-69% therefore 6-31% of the masked hypertensives were not detected. The specificity ranged from 98-94% therefore 1-6% of patients were wrongly classified as masked hypertensives. A limited number of home and office BP measurements allowed the detection of masked hypertension with a high specificity and a low sensitivity. A sufficient number of measurements (three measurements at two visits for OBP and three measurements in the morning and in the evening over 2 days for HBP) are required to diagnose masked hypertension.

High prevalence of masked hypertension in treated hypertensive patients with type 2 diabetes mellitus

P-7 Key Words: Hypertension, Diabetes, Masked Hypertension

Masked hypertension in children and young adults.

Masked hypertension, a high ambulatory blood pressure (ABP) in the presence of normal office blood pressure (BP), is recognized as a risk factor for cardiovascular complications in the adult population. We evaluated the prevalence of masked hypertension in pediatric patients. We studied 136 patients (59 boys and 77 girls, aged 6-25 years, mean 13.1+/-4.7 years). In all patients, office BP measurements with auscultatory technique were less than the 95th percentile for sex and age or <140/90 mmHg for those over 18 years. Masked hypertension was diagnosed when either systolic or diastolic daytime ABP values were equal to or greater than the 95th percentile for sex and height of reference values or > or =135 mmHg systolic or 85 mmHg diastolic BP for those over 15 years. Among 136 patients, 15 (11%) had masked hypertension. The prevalence of masked hypertension was higher in boys (19%) than in girls (5%), but not different between younger (< or =15 years) and older (>15 years) patients (11% vs. 12%). The diagnoses in the group with masked hypertension included 3 patients with diabetic nephropathy, 2 with obesity, and 2 with orthostatic dysregulation. In conclusion, masked hypertension is present in pediatric patients, and is more common in boys. Further study is needed to identify patients who may benefit from recognition of masked hypertension.