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

Abstract

The association between masked hypertension and metabolic syndrome (MS) or insulin resistance is unclear. We investigated an untreated nationwide population sample (n = 1582, age 44-74 years). Duplicate office blood pressure (BP) measurements were taken on one visit and duplicate morning and evening home measurements were taken for 7 days. Masked hypertension was defined as office BP < 140/90 mm Hg with home BP ⩾ 135/85 mm Hg. Logistic regression analysis was used to determine the association between masked hypertension and metabolic risk factors. Age- and gender-adjusted odds ratios for metabolic disorder were 2.89 (1.87-4.47), 2.93 (2.15-3.97) and 1.68 (1.05-2.70) in white-coat hypertension, 3.39 (2.00-5.76), 3.86 (2.61-5.72) and 2.77 (1.63-4.70) in masked hypertension, and 7.38 (5.19-10.49), 6.45 (4.92-8.46) and 4.27 (3.00-6.08) in sustained hypertension using European Group for the Study of Insulin Resistance, harmonised MS and homeostasis model assessment of insulin resistance above the 80th percentile criteria. When home BP was used to define MS, masked hypertension moved close to sustained hypertension. The association between masked hypertension and metabolic disorders was related to home BP, body mass index and waist circumference. In conclusion, home BP appears to be a useful method to assess the risk of metabolic disorder. Masked hypertensives would benefit from the use of home BP in the definition of MS.

Hypertension prevalence, awareness, treatment and control in the over 50s in Ireland: evidence from The Irish Longitudinal Study on Ageing

“…46 Equally, some participants with true hypertension may have been misclassified as normotensive, often termed 'masked hypertension'. 47 Masked hypertension is estimated to occur in 8-23% of those with normal BP readings, 48 resulting in an underestimate of the prevalence of hypertension in this study. White coat hypertension and masked hypertension create difficulties in classifying hypertension based on single BP readings, as a result a minimum of two readings are required for epidemiological studies 15 and current clinical guidelines recommend ambulatory BP measurement to confirm a diagnosis of hypertension.…”

Masked Hypertension

“…14,15 Finally, the presence of metabolic syndrome, diabetes mellitus, chronic kidney disease, shortened sleep time, or obstructive sleep apnea may predispose to masked hypertension largely because of nocturnal hypertension. [16][17][18][19][20] Indeed, elevated nighttime BP and nondipping or rising nocturnal BP patterns, with or without elevated daytime ABPM values, may be associated with normal conventional office BP values, and hence with a diagnosis of masked hypertension. [20][21][22] In summary, there is a need for 24-hour ABPM with assessment of both day and nighttime BP to diagnose masked hypertension in the many conditions where it might occur.…”

“…[34][35][36][37] Importantly, a meta-analysis done by Hodgkinson et al 38 concluded that neither office nor HBPM had sufficient sensitivity nor specificity to replace ABPM as the reference standard. A further advantage of ABPM over HBPM is the ability to identify patients with normal daytime but nocturnal masked hypertension.…”

“…14,15 Por último, la presencia del síndrome metabólico, diabetes mellitus, enfermedad renal crónica, acortamiento del tiempo de sueño o apnea obstructiva del sueño puede predisponer a la hipertensión enmascarada, en gran parte, como consecuencia de la hipertensión nocturna. [16][17][18][19][20] De hecho, los patrones de PA nocturna elevada y que no disminuye al acostarse o aumento de la PA nocturna, con o sin valores de MAPA diurno pueden estar relacionados con valores normales de la PA en consultorio convencional, y por consiguiente con un diagnóstico de hipertensión enmascarada. [20][21][22] En resumen, es necesario el MAPA de 24 horas con evaluación de la PA tanto diurna como nocturna para diagnosticar hipertensión enmascarada en la cantidad de situaciones en las que puede ocurrir.…”

“…[34][35][36][37] De manera significativa, un metanálisis realizado por Hodgkinson et al 38 concluyó que ni la PA en consultorio ni el MDPA tenían sensibilidad ni especificidad suficientes para reemplazar el MAPA como estándar de referencia. Una ventaja adicional del MAPA sobre el MDPA es la habilidad para identificar a los pacientes con hipertensión diurna normal pero nocturna enmascarada.…”