What is the clinical evidence from this study?

Study design: Cohort. Population: Prehypertension (n=8883). Intervention: Masked hypertension and non-dipper blood pressure pattern vs. Normotension and dipper blood pressure pattern. Primary outcome: Arterial stiffness (brachial-ankle pulse wave velocity ≥1800 cm/s) (OR 2.86, 95% CI 2.41-3.40).

What does this research mean for the field?

Masked hypertension and abnormal nocturnal blood pressure dipping patterns significantly increase the risk of arterial stiffness in individuals with prehypertension, particularly those aged 35-59 years. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess the association between masked hypertension, nocturnal dipping status, and the risk of arterial stiffness in individuals with prehypertension.

June 3, 2026

Risk of Arterial Stiffness Associated With Masked Hypertension and Nocturnal Dipping Status Measured by Ambulatory Blood Pressure Monitoring in Population With Prehypertension

Key Result

Masked day-night hypertension (OR 2.86; 95% CI 2.41-3.40) and a non-dipper blood pressure pattern (OR 1.19; 95% CI 1.02-1.39) were significantly associated with increased arterial stiffness.

Key Points

To assess the association between masked hypertension, nocturnal dipping status, and the risk of arterial stiffness in individuals with prehypertension.
Community-based prospective cohort design
Enrolled 9,693 prehypertensive participants aged 35-80 years
Utilized 24-hour ambulatory blood pressure monitoring
48.8% experienced masked hypertension
Isolated daytime hypertension had an OR of 1.95 (95% CI 1.40–2.73) for arterial stiffness
Non-dipper pattern had an OR of 1.19 (95% CI 1.02–1.39) compared to the dipper pattern

Study Design

Type

Cohort (n=8,883)

Structured PICO

Do masked hypertension and abnormal nocturnal dipping status increase the risk of arterial stiffness in prehypertensive individuals?

Population

8,883 prehypertensive adults aged 35-80 years, not on antihypertensive medications, evaluated for arterial stiffness using ambulatory blood pressure monitoring.

Exposure

Masked hypertension (isolated nocturnal, isolated daytime, or day-night hypertension) and abnormal nocturnal dipping status (non-dipper or riser) assessed by 24-hour ambulatory blood pressure monitoring.

Comparator

Normotension and normal nocturnal dipping status (dipper pattern).

Outcome

Arterial stiffness, defined as brachial-ankle pulse wave velocity ≥1800 cm/s.surrogate

Masked hypertension and abnormal nocturnal blood pressure dipping patterns are significantly associated with increased arterial stiffness in prehypertensive individuals, highlighting the value of ambulatory blood pressure monitoring for early risk stratification.

Main Result

Odds Ratio: 2.86 (95% CI 2.41–3.4)

Abstract

Objective: To determine the risk of arterial stiffness associated with masked hypertension and the circadian rhythm of blood pressure (BP) in individuals with prehypertension (office BP of 120-139/80-90 mmHg). Design and method: The Ambulatory 24-hour Blood Pressure Monitoring (ABPM) and Evaluation of Cardiovascular Risk in Prehypertensive Population (AMEC-Pre; ChiCTR2300073286) is a community-based prospective cohort study designed to provide evidence-based guidance for better management of BP in China. Between March 2023 and May 2024, the study enrolled 9,693 prehypertensive participants aged 35–80 years who had not taken any antihypertensive medications in the past 3 months. A total of 8,883 participants were included in the final analysis. Masked hypertension was defined as an office BP of <140/90 mmHg, and ABPM at least 130/80 mmHg over 24 hours or at least 135/85 mmHg for daytime average or at least 120/70 mmHg for nighttime average. Nocturnal dipping status was defined based on the BP reduction while asleep versus awake: extreme dipper (at least 20%); dipper (10% to <20%); non-dipper (0% to <10%); and riser (any increase). Arterial stiffness was defined as a brachial-ankle pulse wave velocity at least 1800 cm/s. Results: Of all, 48.8% had masked hypertension and 43.6% had a non-dipper pattern at self-reported bed time. The risk of arterial stiffness was elevated in individuals with isolated nocturnal hypertension (odds ratio OR 1.65, 95% confidence interval CI 1.38–1.97), isolated daytime hypertension (OR 1.95, 95%CI 1.40–2.73), and day-night hypertension (OR 2.86, 95%CI 2.41–3.40). The risk was also higher in prehypertensive individuals aged 35-59 years than in those aged 60-80 years (P for interaction=0.04). Elevated risk of arterial stiffness was observed in non-dipper pattern (OR 1.19, 95%CI 1.02–1.39) and riser pattern (OR 1.26, 95%CI 1.02–1.55) compared with the dipper pattern. This relationship remained consistent when using the fixed clock-time intervals (daytime, 7 AM to 10 PM; nighttime,10 PM to 7 AM). Conclusions: The risk of arterial stiffness was significantly associated with masked hypertension and nocturnal dipping status in prehypertensive individuals, especially those aged 35-59 years. Community-based ABPM is important to identify masked hypertension, thereby guiding early preventive strategies for arterial stiffness.

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