Diagnosing Masked Hypertension Using Ambulatory Blood Pressure Monitoring, Home Blood Pressure Monitoring, or Both?

Abstract

Guidelines recommend measuring out-of-clinic blood pressure (BP) to identify masked hypertension (MHT) defined by out-of-clinic BP in the hypertensive range among individuals with clinic-measured BP not in the hypertensive range. The aim of this study was to determine the overlap between ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) for the detection of MHT. We analyzed data from 333 community-dwelling adults not taking antihypertensive medication with clinic BP<140/90 mmHg in the Improving the Detection of Hypertension Study. Any MHT was defined by the presence of daytime MHT (mean daytime BP≥135/85 mmHg), 24-hour MHT (mean 24-hour BP≥130/80 mmHg), and/or nighttime MHT (mean nighttime BP≥120/70 mmHg). Home MHT was defined as mean BP≥135/85 mmHg on HBPM. The prevalence of MHT was 25.8% for any MHT and 11.1% for home MHT. Among participants with MHT on either ABPM and/or HBPM, 29.5% had MHT on both ABPM and HBPM; 61.1% had MHT only on ABPM; and 9.4% of participants had MHT only on HBPM. After multivariable adjustment and compared to participants without MHT on ABPM and HBPM, those with MHT on both ABPM and HBPM and only on ABPM had a higher left ventricular mass index (mean difference [standard error, SE] 12.7 [2.9] g/m2, p<0.001; and 4.9 [2.1] g/m2, p=0.022, respectively), whereas participants with MHT only on HBPM did not have an increased left ventricular mass index (mean difference [SE] −1.9 [4.8] g/m2, p=0.693). These data suggest that conducting ABPM will detect many individuals with MHT who have an increased cardiovascular disease risk.

Validation of two watch‐type wearable blood pressure monitors according to the ANSI/AAMI/ISO81060‐2:2013 guidelines: Omron HEM‐6410T‐ZM and HEM‐6410T‐ZL

“…10,11 Recently, the clinical significance of daytime MHT defined by hypertensive daytime out-of-clinic BP measured by ambulatory BP monitoring (ABPM) and normotensive clinic BP has been highlighted: Namely, compared with individuals without MHT as measured by daytime ABPM or home BP measurement (HBPM), individuals with MHT by these measures have an increased risk for TOD compared to those with MHT only on HBPM. 12 Furthermore, there is growing evidence that daytime BP variability (BPV) is an independent predictor of hypertensive TOD and CV events. 13,14 Therefore, measurement of daytime BP is important to stratify CV risk in detail.…”

Current status of ambulatory blood pressure monitoring in Asian countries: A report from the HOPE Asia Network

“…In a recent study, the detection rate of masked hypertension in a population without history of antihypertensive drug treatment and clinic BP of <140/90 mm Hg was reported to be much higher in ABPM than in HBPM; moreover, the left ventricular mass index was increased only in patients with masked hypertension based on ABPM findings . Because of the characteristics of this study population, the conclusion could be generalized easily.…”

Left ventricular hypertrophy in isolated and dual masked hypertension

“…Disagreement between home and ABPM criteria in diagnosing MH has also been reported in the few previous studies carried out in population‐based samples or in patients attending hypertension clinics. In such studies, the diagnostic agreement of the two BP measurement methods in identifying out‐of‐office hypertension ranged from 32% to 48% suggesting that dual or complete MH can be diagnosed in less than half of the subjects with office normotension. Third, as compared participants with partial MH to those with dual MH had a worse metabolic profile, greater prevalence of obesity, and higher average office and out‐of‐office BP values, all important pathogenetic factors for development and progression of cardiac HMOD.…”