High prevalence of masked uncontrolled hypertension in people with treated hypertension.
OBJECTIVE
There are limited data on the quality of treated blood pressure (BP) control during normal daily life, and in particular, the prevalence of 'masked uncontrolled hypertension' (MUCH) in people with treated and seemingly well-controlled BP is unknown. This is important because masked hypertension in 'treatment naïve' patients is associated with a high risk of cardiovascular events. We therefore conducted the first study to define the prevalence and characteristics of MUCH among a large sample of hypertensive patients in routine clinical practice in whom BP was treated and controlled to recommended clinic BP goals.


RESULTS
We analysed data from the Spanish Society of Hypertension ambulatory blood pressure monitoring (ABPM) Registry and identified patients with treated and controlled BP according to current international guidelines (clinic BP <140/90 mmHg). Masked uncontrolled hypertension was diagnosed in these patients if despite controlled clinic BP, the mean 24-h ABPM average remained elevated (24-h systolic BP ≥130 mmHg and/or 24-h diastolic BP ≥80 mmHg). From 62 788 patients with treated BP in the Spanish registry, we identified 14 840 with treated and controlled clinic BP, of whom 4608 patients (31.1%) had MUCH according to 24-h ABPM criteria (mean age 59.4 years, 59.7% men). The prevalence of MUCH was significantly higher in males, patients with borderline clinic BP (130-9/80-9 mmHg), and patients at high cardiovascular risk (smokers, diabetes, obesity). Masked uncontrolled hypertension was most often because of poor control of nocturnal BP, with the proportion of patients in whom MUCH was solely attributable to an elevated nocturnal BP almost double that solely attributable to daytime BP elevation (24.3 vs. 12.9%, P < 0.001).


CONCLUSIONS
The prevalence of masked suboptimal BP control in patients with treated and well-controlled clinic BP is high. Clinic BP monitoring alone is thus inadequate to optimize BP control because many patients have an elevated nocturnal BP. These findings suggest that ABPM should become more routine to confirm BP control, especially in higher risk groups and/or those with borderline control of clinic BP.
Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ - CIBER in Epidemiology and Public Health (CIBERESP), AvdaArzobispoMorcillo 2, 28029 Madrid, Spain joseramon.banegas@uam.es.
José R
JR
Banegas
Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ - CIBER in Epidemiology and Public Health (CIBERESP), AvdaArzobispoMorcillo 2, 28029 Madrid, Spain Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain.
Luis M
LM
Ruilope
Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Barcelona, Spain.
Alejandro
A
de la Sierra
Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ - CIBER in Epidemiology and Public Health (CIBERESP), AvdaArzobispoMorcillo 2, 28029 Madrid, Spain.
Juan J
JJ
de la Cruz
Department of Nephrology, Hospital Universitario Central de Asturias, Oviedo, Spain.
Manuel
M
Gorostidi
Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain.
Julián
J
Segura
Hypertension Unit, Hospital Clínico San Carlos, Madrid, Spain.
Nieves
N
Martell
Cardiometabolic and Hypertension Unit, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain.
Juan
J
García-Puig
National Centre for Cardiovascular Prevention and Outcomes, 170 Tottenham Court Road, London W1T 7HA, UK.
John
J
Deanfield
Institute of Cardiovascular Sciences and NIHR University College London Hospitals Biomedical Research Centre, University College London, 170 Tottenham Court Road, London W1T 7HA, UK.
Bryan
B
Williams
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries; D012307:Risk Factors; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology
D000959:Antihypertensive Agents
Ambulatory blood pressure monitoring; Guidelines; MUCH; Masked; Uncontrolled hypertension