Masked Arterial Hypertension in Middle-Age Patients and the Elderly. Prevalence, Cardiovascular Risk Factors and Some Long-Term Risk Trends

Abstract

Objective:To assess frequency of masked hypertension (MAH) in middle-aged patients and in the elderly, the prevalence of cardiovascular risk factors (CV RF) with special aspects to pts with type 2 diabetes mellitus (T2D) and long-term prognosis trends of subjects with MAH.Design and method:A screening study that included 314 consecutive patients aged 35–74 years with normal in-office blood pressure (BP) in hypertension centre. Participants were performed to identify cardiovascular risk factors, underwent following 24-hours blood pressure monitoring to verify the MAH diagnosis, too. Patients with confirmed MAH were periodically clinically monitored for an average of 5.5 years (3.5–7 yrs).Results:MAH was detected in the age category of 45–54 years, in 24.2 % and 9.9 % women, 55–64 years, in 19.4% men and 8.1 % women. Middle-aged and elderly men with MAH frequently identified CV RF compared to evenly aged women - family history of CV diseases, higher rate of smoking and dyslipidemia, lower physical activity prevailed. From a patients with the diagnosis of T2D, a total 44.3% presented normal in-office BP and the pts with the diagnosed MAH were older (63.9 vs. 54.7 years; p < 0.001), also with earlier diagnosis of T2D, higher rate of smokers (26.4 % vs. 1.9%; p = 0.002), and higher levels of HbA1c (10.7 % vs. 9.9%; p = 0.006), creatinine (0.73 vs. 0.65 mg/dl; p = 0.040), and microalbuminuria (139.4 vs. 27.4 mcg/mg; p < 0.001). Patients with MAH at the beginning of the study had long-term risk of progression to sustained office hypertension in 37.9 %, increased frequency of developing T2D 9.3 % and in the two oldest cohorts we observed a trend for a lower cognitive score on the MMSE.Conclusions:MAH is common finding in patients especially in the age category of 45–54 and 55–64 years, in males, smokers ith unfavourable risk profile, and it is also common in diabetics. MAH is associated with progression to sustained office hypertension, increased frequency of developing T2D and in the oldest cohort, patients may show decreased cognitive function compared to patients with normotension.