Masked hypertension: understanding its complexity.
Masked hypertension, which is present when in-office normotension translates to out-of-office hypertension, is present in a surprisingly high percentage of untreated persons and an even higher percentage of patients after beginning antihypertensive medication. Not only are persons with prehypertension more likely to have masked hypertension than those with optimal blood pressure (BP), but also they frequently develop target organ damage prior to transitioning to sustained hypertension. Furthermore, the frequency of masked hypertension is high in individuals of African inheritance and in the presence of increased cardiovascular risk factors and disease states, such as diabetes and chronic renal failure. Nocturnal hypertension and non-dipping may be early markers of masked hypertension. Twenty-four hour ambulatory BP monitoring (ABPM), which can detect nighttime and 24 h elevated BP, remains the gold standard for diagnosing masked hypertension. Almost one-third of treated patients with masked hypertension remain as 'masked uncontrolled hypertension', and it becomes important, therefore, to use ABPM (and supplemental home BP monitoring) for the effective diagnosis and control of hypertension.
Heart Disease Prevention Program, Division of Cardiology, Department of Medicine, C240 Medical Sciences (Offices C340A-B), University of California, Irvine, CA 92697-4079, USA.
Stanley S
SS
Franklin
Conway Institute of Bimolecular and Biomedical Research, University College, Dublin, Dublin, Ireland.
Eoin
E
O'Brien
Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiological KLI Leuven, Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
Jan A
JA
Staessen
D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology; D048909:Diabetes Complications / Q000150:complications; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005544:Forecasting; D006801:Humans; D059468:Masked Hypertension / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D024821:Metabolic Syndrome / Q000209:etiology; D010819:Physician's Role; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012307:Risk Factors; D009626:Terminology as Topic
Ambulatory blood pressure monitoring ; Cardiovascular disease ; Dipping status; Hypertension ; Masked hypertension ; Masked uncontrolled hypertension ; Nocturnal hypertension 