Should we screen for masked hypertension in patient with vascular disease?
BACKGROUND
The influence of hypertension on cardiovascular risk is well known. Ambulatory blood pressure measurement (ABPM) is able to identify patients with masked hypertension (MH) underdetected by clinical BP measurement. The benefit of screening for MH in a high-risk population was investigated.


OBJECTIVE
To detect MH in a population with no prior history of hypertension and medically treated for peripheral or coronary arterial disease.


METHODS
Thirty-eight consecutive patients with peripheral or coronary artery disease documented with arteriography, without a history of hypertension, and with an admission BP < 140/90 mmHg underwent ABPM after discharge. Ambulatory BP >or= 125/80 mmHg were defined as MH.


RESULTS
MH was found in 11 patients (28.9%). The MH group had a mean systolic and diastolic hospitalization BP significantly higher (127 versus 115 mmHg, respectively, P = 0.002 and 76 versus 66 mmHg, P = 0.01), and tended to have a higher admission systolic BP and pulse pressure (127 versus 121 mmHg, respectively, P = 0.07; and 54 versus 46 mmHg, P = 0.06). The first BP measurement on the 24-hour ABPM was significantly higher in the MH group 140 versus 121 mmHg, P = 0.001, for systolic BP and 84 versus 74 mmHg, P = 0.03, for diastolic BP.


CONCLUSIONS
MH was found in patients with documented and medically treated vascular disease. BP in the prehypertensive range is associated with MH. Systematic screening for MH in this high-risk population requires further investigation.
Service de Médecine Vasculaire et Hypertension Artérielle, University Hospital of Lille, France. delsartpascal@yahoo.fr
Pascal
P
Delsart
Philippe
P
Marboeuf
Cedric
C
Delhaye
Gilles
G
Lemesle
Claire
C
Mounier-Vehier
D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D003324:Coronary Artery Disease / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010343:Patient Admission; D010351:Patient Discharge; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D011379:Prognosis; D013997:Time Factors