Detection of masked hypertension and the 'mask effect' in patients with well-controlled office blood pressure.
BACKGROUND
Masked hypertension (MH) is characterized by its hidden nature and poor prognosis. However, it is not practical to routinely recommend home or ambulatory blood pressure monitoring (HBP or AMBP) to all patients with apparently well-controlled BP. The purpose of this study is to present, within the group of patients with well-controlled office BP (OBP), the clinical predictors of MH and to evaluate the gap (ie, the `mask effect' (ME)) between OBP and HBP.


RESULTS
BP was measured at the outpatient clinic and at home in 1,019 treated hypertensive patients. Candidate predictors for MH were analyzed within 511 patients with well-controlled OBP (45.6% men, 57.1±9.0 years). Among them, the prevalence of MH was 20.9% (n=107). In the multivariate-adjusted analysis, the risk of MH increased with high serum fasting blood glucose level (odds ratio (OR) 1.009, 95% confidence interval (CI): 1.001-1.018, P=0.020), higher systolic OBP (OR 1.075, 95%CI 1.045-1.106, P<0.001), higher diastolic OBP (OR 1.045, 95%CI 1.007-1.084, P=0.019) and the number of antihypertensive medications (OR 1.320, 95%CI 1.113-1.804, P=0.021). Furthermore, systolic HBP correlated well with systolic OBP (r=0.351, P<0.001) and with the degree of systolic ME (r=-0.672, P<0.001).


CONCLUSIONS
To recognize MH, it is practical to investigate those patients who are taking multiple antihypertensive drugs and have a high OBP with a high FBG level. The term "ME" identifies MH more appropriately than the term "negative white-coat effect".
SungKyunKwan University, Samsung Medical Center, Seoul, Republic of Korea.
Sung-Ji
SJ
Park
Jeong Bae
JB
Park
Dong-Ju
DJ
Choi
Ho Joong
HJ
Youn
Chang Gyu
CG
Park
Young Keun
YK
Ahn
Joon-Han
JH
Shin
Dong Woon
DW
Kim
Se Joong
SJ
Rim
Jang Ho
JH
Bae
Hyun Young
HY
Park
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000032:analysis; D018660:Blood Pressure Monitoring, Ambulatory; D002097:C-Reactive Protein / Q000032:analysis; D057210:Delayed Diagnosis; D003971:Diastole; D005215:Fasting / Q000097:blood; D005260:Female; D006785:Hospitals, University; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D015995:Prevalence; D013599:Systole
D000959:Antihypertensive Agents; D001786:Blood Glucose; D008055:Lipids; D002097:C-Reactive Protein