Prognostic Value of Masked Uncontrolled Hypertension

Abstract

The prognostic relevance of masked uncontrolled hypertension (MUCH) is incompletely clear and its global impact on cardiovascular outcomes and mortality has not been assessed. The aim of this study was to perform a meta-analysis on the prognostic value of MUCH. We searched for articles assessing outcome in patients with MUCH compared to those with controlled hypertension and reporting adjusted hazard ratio and 95% confidence interval. We identified six studies using ambulatory blood pressure monitoring (12610 patients with 933 events) and five using home blood pressure measurement (17742 patients with 394 events). The global population included 30352 patients who experienced 1327 events. Selected studies had cardiovascular outcomes and all-cause mortality as primary outcome and the main result is a composite of these events. The overall adjusted hazard ratio was 1.80 (95% confidence interval 1.57–2.06) for MUCH versus controlled hypertension. Subgroup meta-analysis showed that adjusted hazard ratio was 1.83 (95% confidence interval 1.52–2.21) in studies using ambulatory blood pressure monitoring and 1.75 (95% confidence interval 1.38–2.20) in those using home blood pressure measurement. Risk was significantly higher in MUCH than in controlled hypertension independently of follow-up length and types of studied events. MUCH was at significantly higher risk than controlled hypertension in all ethnic groups, but the highest hazard ratio was found in studies including Black patients. Risk of cardiovascular events and all-cause mortality is significantly higher in patients with MUCH than in those with controlled hypertension. MUCH detected by ambulatory or home blood pressure measurement appear to convey similar prognostic information.

Association of masked uncontrolled hypertension and cardiovascular diseases in treated hypertensive patients

“…However, some other studies did not observe such an association after adjustment for potential confounding factors [32]. Recently, one systemic review and meta-analysis indicated that in 30 352 treated hypertensive patients with normal clinic BP, risks of cardiovascular events and all-cause mortality were higher in those with MUCH [33], which was defined by the same criteria as those used in our current study. Consistent with the recent published systemic review and meta-analysis [33], our current study also showed that in treated Chinese hypertensive patients, compared to those without masked hypertension, patient with MUCH had a higher absolute and relative risk of prevalent cardiovascular diseases.…”

“…Recently, one systemic review and meta-analysis indicated that in 30 352 treated hypertensive patients with normal clinic BP, risks of cardiovascular events and all-cause mortality were higher in those with MUCH [33], which was defined by the same criteria as those used in our current study. Consistent with the recent published systemic review and meta-analysis [33], our current study also showed that in treated Chinese hypertensive patients, compared to those without masked hypertension, patient with MUCH had a higher absolute and relative risk of prevalent cardiovascular diseases. Findings from our current study support the notion that a future randomized clinical trial should be conducted to evaluate whether improvement of out-of-clinic BP could further reduce cardiovascular risk in MUCH patients [34].…”

Diabetic Cardiovascular Autonomic Neuropathy, the Handgrip Test and Ambulatory Blood Pressure Monitoring Parameters: Are There Any Diagnostic Implications?

“…Moreover, 24-h ABPM is considered to be the gold standard for diagnosing masked-hypertension [ 18 ]. The prevalence of masked-hypertension ranges up to 20% in population-based studies [ 19 ] and it is associated with target-organ damage and poor prognosis [ 20 ]. In the present study, more than 60% of our diabetic patients with no hypertension at baseline could be diagnosed with hypertension upon ABPM reflecting that masked-hypertension is a highly common disorder in diabetic patients.…”

The further development of out‐of‐office BP monitoring: Japan's ImPACT Program Project's achievements, impact, and direction

“…Ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) are the two standard measurements of out‐of‐office BP. Their use can detect masked (uncontrolled) hypertension (normotension in office BP and hypertension in out‐of‐office BP) in individuals at the highest risk of cardiovascular events . There are three clinical phenotypes of masked hypertension: morning hypertension, daytime hypertension, and nocturnal hypertension …”