What is the clinical evidence from this study?

Study design: Cohort. Population: White-coat and masked hypertension (n=1332). Intervention: Masked hypertension vs. Sustained normal blood pressure. Primary outcome: Composite risk of cardiovascular mortality and stroke morbidity (RH 2.13, 95% CI 1.38-3.29).

What does this research mean for the field?

Masked hypertension is associated with an approximately two-fold increase in the risk of cardiovascular mortality and stroke morbidity compared to sustained normal blood pressure, whereas white-coat hypertension is not associated with increased risk. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study investigates the long-term prognosis of individuals with masked and white-coat hypertension using ambulatory blood pressure monitoring.

June 15, 2026Journal of the American College of Cardiology

Prognosis of “Masked” Hypertension and “White-Coat” Hypertension Detected by 24-h Ambulatory Blood Pressure Monitoring

Q: What are the key findings of this study?

Masked hypertension (RH 2.13; 95% CI 1.38-3.29), but not white-coat hypertension (RH 1.28; 95% CI 0.76-2.14), was associated with a higher risk of cardiovascular events than normal blood pressure.

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Key result

Masked but not white-coat hypertension linked to ~113% greater cardiovascular risk versus normal BP.

RH 2.13
95% CI 1.38-3.29
n=1,332

Why the study?

The prognostic significance of white-coat hypertension remained controversial, and little was known about the prognosis of masked hypertension.

Does masked hypertension or white-coat hypertension increase the risk of cardiovascular mortality and stroke morbidity compared to sustained normal BP in the general population?

Key Points

This study investigates the long-term prognosis of individuals with masked and white-coat hypertension using ambulatory blood pressure monitoring.
Analyzed 24-h ambulatory blood pressure and casual BP from 1,332 subjects aged 40 and older.
Followed up for a mean duration of 10 years to assess cardiovascular mortality and stroke morbidity.
Employed Cox proportional hazards regression model for risk assessment.
WCHT shows no significant increase in risk for cardiovascular mortality (RH 1.28, 95% CI 0.76-2.14) compared to sustained normal BP.
MHT presents a higher risk for cardiovascular mortality (RH 2.13, 95% CI 1.38-3.29) compared to sustained normal BP.
Sustained hypertension also shows higher risk (RH 2.26, 95% CI 1.49-3.41) compared to sustained normal BP.

Study Design

Type

Cohort (n=1,332)

Structured PICO

Does masked hypertension or white-coat hypertension increase the risk of cardiovascular mortality and stroke morbidity compared to sustained normal BP in the general population?

Population

1,332 adults aged ≥40 years from a Japanese community, followed for a mean of 10 years to assess cardiovascular outcomes associated with white-coat and masked hypertension.

Exposure

Masked hypertension (casual BP <140/90 mm Hg, daytime BP ≥135/85 mm Hg) and white-coat hypertension (casual BP ≥140/90 mm Hg, daytime BP <135/85 mm Hg) detected by 24-h ambulatory BP monitoring.

Comparator

Sustained normal BP (casual BP <140/90 mm Hg, daytime BP <135/85 mm Hg).

Outcome

Composite risk of cardiovascular mortality and stroke morbidity over a mean follow-up of 10 years.composite

Main Result

Hazard Ratio: 2.13 (95% CI 1.38–3.29)

Masked hypertension, but not white-coat hypertension, carries a significantly increased risk of cardiovascular mortality and stroke comparable to sustained hypertension, emphasizing the prognostic value of ambulatory BP monitoring.

Discussion

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Key expert perspectives

Captured external expert commentary on this paper, strongest first. Original sources are linked where available.

WV Willem VerberkResearcher, Maastricht University Medical Centre

“The BP level may have been decreased coincidently during the single-office BP measurement owing to BP variability. In addition, one-third of the subjects classified as masked hypertensive received antihypertensive treatment and may have taken their medication a few hours before the visit, leading to decreased BP levels at the time of measurement.”

Maastricht University Medical CentreEditorial

FW F. Wilford GerminoInternist, Orland Primary Care Specialists

“The cardiovascular risks associated with masked hypertension approach that of sustained hypertension and exceed that associated with white-coat hypertension.”

Orland Primary Care SpecialistsEditorial

PWPeter W. de LeeuwProfessor of Medicine, Maastricht University

“The prognosis of patients with masked hypertension is at least comparable to that of patients with sustained hypertension.”

Maastricht University Medical CentreEditorial

Implication

Masked hypertension signals higher CV risk missed by office BP; leaves open whether ABPM-guided therapy improves outcomes.

Cite This Study

Ohkubo et al. (2005) conducted a cohort in White-coat and masked hypertension (n=1,332). Masked hypertension vs. Sustained normal blood pressure was evaluated on Composite risk of cardiovascular mortality and stroke morbidity (RH 2.13, 95% CI 1.38-3.29). Masked hypertension (RH 2.13; 95% CI 1.38-3.29), but not white-coat hypertension (RH 1.28; 95% CI 0.76-2.14), was associated with a higher risk of cardiovascular events than normal blood pressure.

synapsesocial.com/papers/6a3017ec24c2c42f24de9f57 https://doi.org/10.1016/j.jacc.2005.03.070

Topics

Hypertension management

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Prognosis of “Masked” Hypertension and “White-Coat” Hypertension Detected by 24-h Ambulatory Blood Pressure Monitoring

Key Points

Study Design

Structured PICO

Main Result

Discussion

Key expert perspectives

Implication

Cite This Study

Topics

Prognosis of “Masked” Hypertension and “White-Coat” Hypertension Detected by 24-h Ambulatory Blood Pressure Monitoring

Key Points

Study Design

Structured PICO

Main Result

Discussion

Key expert perspectives

Implication

Cite This Study

Also Consider

Topics

Also Consider