Masked hypertension—what lies ahead?

Anstey, D. Edmund; Shimbo, Daichi

doi:10.1038/jhh.2017.11

Cited by 8 publications

(8 citation statements)

References 17 publications

(26 reference statements)

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“…29,30 However, few data exist on the CVD risk associated with MHT when present on ABPM and not HBPM or when present on HBPM but not ABPM. 24 In the primary analysis, participants with MHT detected on ABPM with or without MHT on HBPM, had a higher LVMI compared to participants without MHT on ABPM and HBPM, whereas LVMI was not higher among participants with MHT only on HBPM. In contrast, in a sensitivity analysis using BP thresholds from the 2017 ACC/AHA BP guideline, LVMI was higher among participants with MHT only on HBPM.…”

Section: Discussionmentioning

confidence: 86%

“…Although these results suggest that MHT is associated with increased CVD risk regardless of which out-of-clinic BP monitoring approach is performed, there is controversy regarding whether ABPM or HBPM is the best approach in clinical practice to diagnose MHT. 16,24 Compared to HBPM, there are more studies demonstrating an association of ABPM with CVD risk. 16,25 Further, ABPM has been the reference standard for measuring BP during the nighttime period and assessing diurnal patterns.…”

Section: Discussionmentioning

confidence: 99%

“…However, many individuals would need to undergo both ABPM and HBPM since a substantial proportion (58/296 = 19.6%) of individuals without MHT on HBPM have any MHT on ABPM. Therefore, despite practical concerns regarding the widespread implementation of ABPM, 7,16,24,31 it may be preferable to HBPM since it will detect the vast majority of participants with MHT.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…(10–12, 35) The optimal approach for the detection of masked hypertension is unknown. (36) Screening all individuals with non-elevated clinic BP for masked hypertension is impractical. For example, Booth et al determined that such an approach in the US would require 118.6 million adults undergo ABPM.…”

Section: Whom To Screenmentioning

confidence: 99%

An Update on Masked Hypertension

et al. 2017

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Masked hypertension refers to the phenomenon of having a non-elevated clinic blood pressure (BP) despite having an elevated out-of-clinic BP. Masked hypertension is a common phenotype with a cardiovascular risk profile similar to that of sustained hypertension, defined as elevated clinic and out-of-clinic BP. Current guidelines offer little guidance on the best practices for detecting and treating masked hypertension. This is in part due to insufficient evidence upon which to base recommendations as many questions remain regarding the optimal clinical management of masked hypertension. In this review, we will discuss the recent literature on masked hypertension related to disease prevalence, diagnosis, screening strategies, adverse outcomes, and treatment, and will highlight critical areas for future research.

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“…ABPM is superior to clinical BP monitoring in detecting and characterizing changes in BP throughout the observation period [13] and in predicting cardiovascular morbidity and mortality [14, 15]. Although the optimal approach for the detection of MHTN is unknown [16, 17], screening individuals with a high risk is the best approach. MHTN has often been shown to progress to sustained HTN in older people and confers a cardiovascular risk almost similar to sustained HTN [18] in both the general population and in patients with diabetes and CKD.…”

Section: Discussionmentioning

confidence: 99%

Masked Hypertension in Adolescents with Type 1 Diabetes Mellitus: An Exploratory Study

Afandi¹,

Bernieh²,

Roubi³

et al. 2021

Dubai Diabetes Endocrinol J

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Introduction: Masked hypertension (MHTN) is the finding of elevated out-of-office blood pressure (BP) measurement. This is a pilot study to evaluate the prevalence of MHTN in adolescents with type 1 diabetes mellitus (T1DM). Patients and Methods: Normotensive, adolescents with T1DM were recruited from Tawam Adolescents Diabetes Clinic at Tawam hospital, Al Ain, UAE. They consented to wear the ambulatory BP monitoring (ABPM) device. The heart rate and ambulatory BP were recorded at 15-min intervals for 24 h. Abnormal systolic BP (SBP) and diastolic BP (DBP) were defined as readings above 135 and 85 mm Hg; respectively. Results: Thirteen patients (10 females) were recruited from “Tawam Adolescents Diabetes Clinic.” The median age was 17 (15–19) years, median BMI 21.4 (14.8–29), and median diabetes duration 9 (3–12) years. All patients had normal retinal examination within the past 12 months. Family history of hypertension (HTN) was present in 6/13 (46%) patients. Office BP measurements revealed a mean DBP ± SD of 72 ± 6.9 mm Hg and mean SBP ± SD116 ± 5.5 mm Hg. The median HbA1c was 8.4% (5.6–13.7) and median GFR 125 mL/min/m2 (87–134). Two patients had microalbuminuria. Twenty-four hour ABPM revealed elevated SBP and DBP in 12.2 and 5.8% of the values; respectively. Further analysis confirmed MHTN in 4 (30%) patients, nondipping pattern of BP in 5 (38%) patients, and elevated pulse pressure in 8 (61.5%) patients. Only 4 (30%) patients had normal studies. Conclusions: ABPM uncovered a very high prevalence of MHTN in our patients. Whenever available, ABPM provides an excellent tool for diagnosis and hence early evaluation and management of HTN in adolescents with T1DM. Well-designed large-scale studies are needed to examine the magnitude of MHTN among adolescents with T1DM.

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Masked hypertension—what lies ahead?

Cited by 8 publications

References 17 publications

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

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

An Update on Masked Hypertension

Masked Hypertension in Adolescents with Type 1 Diabetes Mellitus: An Exploratory Study

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