Masked hypertension: evidence of the need to treat

Abstract

The diagnosis of masked hypertension has been made easier with the widespread availability of home blood pressure monitoring devices with levels of accuracy comparable to ambulatory blood pressure monitoring. The negative impact of masked hypertension on cardiovascular morbidity and mortality is evidenced by numerous well-designed clinic-based and population-based studies. The relationship of masked hypertension and target organ damage is also well documented. These two factors, combined with the robust evidence of reduced cardiovascular morbidity and mortality achieved with blood pressure treatment, makes the argument for actively identifying patients with masked hypertension and prescribing treatment similar to that for patients with sustained hypertension. In this paper, we review the evidence for the cardiovascular prognosis of masked hypertension compared with sustained hypertension, we review its impact on target organ damage, we propose an algorithm for the treatment of patients with masked hypertension, and we point out the pitfalls in adopting such an approach.

Fig. 1

Cardiovascular prognosis of masked hypertension. This shows a meta-analysis of the six cohort studies comparing quantitative data for the cardiovascular prognosis of patients with masked hypertension with data for normotensive individuals or patients with controlled hypertension. The boxes and horizontal lines represent the hazard ratio and 95% confidence interval for each cohort. MH—masked hypertension. (Adapted from Bobrie et al. [3], with permission)

Fig. 2

Algorithm for evaluating and treating masked hypertension. BP—blood pressure