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Meta-Analysis
. 2018 Oct;72(4):862-869.
doi: 10.1161/HYPERTENSIONAHA.118.11499.

Prognostic Value of Masked Uncontrolled Hypertension

Sante D Pierdomenico  1 , Anna M Pierdomenico  2 , Francesca Coccina  2 , Denis L Clement  3 , Marc L De Buyzere  3 , Dirk A De Bacquer  4 , Iddo Z Ben-Dov  5 , Wanpen Vongpatanasin  6 , José R Banegas  7 , Luis M Ruilope  7 , Lutgarde Thijs  8 , Jan A Staessen  8   9
Affiliations
Meta-Analysis

Prognostic Value of Masked Uncontrolled Hypertension

Sante D Pierdomenico et al. Hypertension. 2018 Oct.

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 with those with controlled hypertension (CH) and reporting adjusted hazard ratio and 95% CI. We identified 6 studies using ambulatory blood pressure monitoring (12 610 patients with 933 events) and 5 using home blood pressure measurement (17 742 patients with 394 events). The global population included 30 352 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% CI, 1.57-2.06) for MUCH versus CH. Subgroup meta-analysis showed that adjusted hazard ratio was 1.83 (95% CI, 1.52-2.21) in studies using ambulatory blood pressure monitoring and 1.75 (95% CI, 1.38-2.20) in those using home blood pressure measurement. Risk was significantly higher in MUCH than in CH independently of follow-up length and types of studied events. MUCH was at significantly higher risk than CH 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 CH. MUCH detected by ambulatory or home blood pressure measurement seems to convey similar prognostic information.

Keywords: blood pressure; hypertension; masked hypertension; mortality; risk.

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Conflict of interest statement

CONFLICT OF INTEREST

None.

Figures

Figure 1.
Figure 1.
Flow chart showing selection of publications. ABPM, ambulatory blood pressure monitoring; CKD, chronic kidney disease; HBPM, home blood pressure measurement.
Figure 2.
Figure 2.
Forest plot showing the adjusted hazard ratio and 95% confidence interval (CI) between patients with masked uncontrolled hypertension (MUCH) and those with controlled hypertension (CH). Data of the OvA, Chieti-Pescara, IDACO, Hadassah, Spanish Registry and Dallas Heart Studies are provided by the authors. Data of the HONEST Study are extracted from Figures 4a and 4b of the manuscript; they are a pooled estimate of values of MUCH patients without diabetes mellitus (including those with chronic kidney disease) and of MUCH patients without chronic kidney disease (including those with diabetes mellitus). Data of the SHEAF, J-HEALTH, IDHOCO and Jackson Heart Studies are published data.
See this image and copyright information in PMC

Comment in

  • Masked Uncontrolled Hypertension.
    Drawz PE. Drawz PE. Hypertension. 2018 Oct;72(4):843-845. doi: 10.1161/HYPERTENSIONAHA.118.11640. Hypertension. 2018. PMID: 30354733 No abstract available.

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