Prevalence and covariates of masked hypertension in ischemic stroke survivors

BACKGROUND: Masked hypertension (MHT) is characterized by normal clinic blood pressure (BP), but elevated ambulatory BP has been associated with a higher prevalence of cardiovascular organ damage. METHODS: We assessed the prevalence and characteristics of MHT in 298 ischemic stroke patients aged 15-60 years. High-normal office BP was considered present if systolic BP was 130-139 mmHg and/or diastolic BP was 85-89 mmHg. Arterial damage was defined as increased pulse wave velocity measured by applanation tonometry and/or mean common carotid intima-media thickness more than 0.9 mm measured by ultrasound. RESULTS: MHT was found in 12% of patients. In multivariable logistic regression analysis, MHT patients were characterized by higher BMI [odds ratio (OR) 1.09; 95% confidence interval (CI) 1.03-1.16], high-normal office BP (OR 2.30; 95% CI 1.26-4.21), and higher serum triglycerides (OR 1.32; 95% CI 1.01-1.47, all P<0.05) in the total study population. Compared with normotensive patients, MHT was characterized by a higher prevalence of high-normal office BP (OR 2.05; 95% CI 1.08-3.90), obesity (OR 2.67; 95% CI 1.31-5.47), and arterial damage (OR 2.87; 95% CI 1.46-5.66, all P<0.05). Compared with patients with sustained hypertension, MHT was associated with a lower prevalence of arterial damage (OR 0.48; 95% CI 0.23-0.99, P=0.05) despite a higher prevalence of high-normal office BP and comparable ambulatory BP values. CONCLUSION: Among young and middle-aged ischemic stroke patients, MHT was found in 12% and associated with high-normal office BP, obesity, and more prevalent arterial damage compared with normotensive patients, underscoring the importance of identification of MHT in these patients.