Important indicators of masked hypertension

Masked hypertension is present when clinic blood pressure is normal <140/90 mmHg, but elevated at home ≥135/85 mmHg. It is an independent hazard for cardiovascular disease and is more common in adults with poor physical activity, diet and smoking habits.

Individuals with such characteristics would benefit from home BP measurements when they appear to have “normal” blood pressure in the office. Important to be aware of masked hypertension as its frequency could be as high as 30% in those with “appropriate” clinic blood pressure values.




October 2016

Masked hypertension is associated with increased risk for cardiovascular disease. Identifying modifiable risk factors for masked hypertension could provide approaches to reduce its prevalence.

Life’s Simple 7 is a measure of cardiovascular health developed by the American Heart Association that includes BMI, physical activity, diet, cigarette smoking, blood pressure(BP), cholesterol, and glucose. We examined the association between cardiovascular health and masked daytime hypertension in the Jackson Heart Study, an exclusively black cohort.

Life’s Simple 7 factors were assessed during a study visit and categorized as poorintermediate, or ideal. Ambulatory BP monitoring was performed after the study visit. Using BP measured between 10 am – 8 pm on ambulatory BP monitoring, masked daytime hypertension was DEFINED as mean clinic <140/90 mm Hg & mean daytime ≥135/85 mm Hg.

Among the 758 participants with systolic BP/diastolic BP <140/90 mm Hg, 30.5% had masked daytime hypertension. The multivariable-adjusted prevalence ratios for masked daytime hypertension comparing participants with 2, 3, and ≥4 versus ≤1 ideal Life’s Simple 7 factors were 0.99 (0.74–1.33), 0.77 (0.57–1.03), and 0.51 (0.33–0.79), respectively.

Masked daytime hypertension was less common among participants with ideal versus poor levels of physical activity (ratio 0.74; 0.56–1.00), ideal or intermediate levels pooled together versus poor diet (prevalence ratio, 0.73; 0.58–0.91), ideal versus poor levels of cigarette smoking (prevalence ratio, 0.61; 0.46–0.82), and ideal versus intermediate levels of clinic BP (prevalence ratio, 0.28, 0.16–0.48).

Better cardiovascular health is associated with a lower prevalence of masked hypertension.