Detection of Masked Hypertension and the Mask Effect' in Patients With Well-Controlled Office Blood Pressure

Abstract

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp he assessment of out-of-office blood pressure (BP), using either ambulatory or home BP monitoring, has enabled detection of masked hypertension (MH) and the "white-coat" hypertension (WCH) phenomena. Studies have shown that MH carries a similar cardiovascular risk to uncontrolled hypertension (UH). 1 Both home BP self-measurement (HBP) and ambulatory BP monitoring (ABPM) have been shown to be better correlated with target organ damage than conventional BP measurement in a clinic office. 2 Moreover, several studies have shown that either self-measured HBP or ABPM can predict cardiovascular mortality and morbidity more accurately than BP measurements at a clinic. 3-5 Even in a patient whose conventionally measured office BP (OBP) is normal, the self-measured HBP or ABPM value may still be high. In other words, UH can remain hidden until self-measurement of HBP or ABPM is performed.The "white-coat" effect (WCE), which is usually defined as the difference between the OBP and HBP (or ABPM), is typically positive and present in the majority of hypertensive patients. 6 The term 'negative WCE' is used when the OBP minus HBP is a negative value. The magnitude of the nega- 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.

Metabolic risk factors and masked hypertension in the general population: the Finn-Home study

“…[14][15][16] Only a Korean study defined masked hypertension using home BP measurement but it investigated treated hypertensive patients. [17][18][19] The majority of the previous studies did not find any significant differences in MS between the BP groups 14,16-20 but only one study investigated all four BP subgroups. That study performed ambulatory BP measurement on 328 untreated, non- proportion of the syndrome was higher in masked (29%) and sustained hypertension (30%) than in normotension (12%) or white-coat hypertension (17%).…”

“…[14][15][16][17][18][19][20] Although the prevalence of MS varies widely depending on the definition used, only three studies reported criteria for the syndrome. [14][15][16] Only a Korean study defined masked hypertension using home BP measurement but it investigated treated hypertensive patients.…”

“…Although patients with MS frequently have high-normal or elevated office, home and ambulatory BP levels, only a few studies have touched briefly on MS or insulin resistance in masked hypertension. 5,7,[14][15][16][17][18][19][20][21][22][23][24] Most of these studies were based on selected patient groups [14][15][16][17][18][19][20][22][23][24] and only a few of them reported the criteria used to define MS. [14][15][16] The majority of them did not find any significant differences between BP subgroups.…”

Management of Home Blood Pressure by Amlodipine Combined With Angiotensin II Receptor Blocker in Type 2 Diabetes

“…The difference of blood pressure between the 2 groups did not become small during the study period, even though all antihypertensive drugs were available through the study period, suggesting that it is not easy to control hypertension without CCB and ARB in diabetic patients, although only they are not enough to control hypertension. Several studies had reported that self-measurement of HBP was useful for detection of insufficient control of blood pressure 17 and it had better prognostic accuracy in terms of both cardiovascular morbidity and mortality than the office measurement. 12,18 HBP measurements have also been shown to predict the damage of target organ by hypertension better than office measurements.…”

High Normal Urine Albumin-to-Creatinine Ratio Predicts Development of Hypertension in Korean Men

“…It is possible that the present study include patients with white-coat hypertension or masked hypertension. 30 Although we could not use more precise diagnostic tools, we think that the prevalence of overestimated hypertension was not so large as to affect the study results. Fifth, although a Korean prospective study showed that short sleep duration could be a risk factor for incident hypertension in postmenopausal women, we could not adjust for sleep duration.…”