Prevalence of hypertension phenotypes in an urban population with low cardiovascular risk in Singapore: a cross-sectional study

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension (Phenotypes) (n=981). Intervention: Ambulatory blood pressure monitoring (ABPM). Primary outcome: Prevalence of nocturnal hypertension.

Q: What does this research mean for the field?

Adults with low cardiovascular risk have a high prevalence of ambulatory hypertension phenotypes, predominantly nocturnal hypertension (36.1%), non-dipping blood pressure patterns (59.7%), and masked hypertension (19.4%). Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Aminath Shiwaza Moosa; Shera Chaterji; Ding Xuan Ng; Barath Kumar; Siew Ching Kong; Weiting Huang; Jonathan Jiunn Liang Yap; Khung Keong Yeo; Chirk Jenn Ng

doi:10.1186/s12889-026-29454-y

October 14, 2026BMC Public HealthOpen Access

Prevalence of hypertension phenotypes in an urban population with low cardiovascular risk in Singapore: a cross-sectional study

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Key result

ABPM detects nocturnal hypertension in ~36% of adults with low cardiovascular risk.

n=981

Why the study?

Population-based evidence on hypertension phenotypes is limited, especially within multi-ethnic urban populations with low cardiovascular risk.

Key Points

To determine the prevalence of hypertension phenotypes and their associated clinical and demographic factors among an urban, multi-ethnic population with low cardiovascular risk in Singapore.
Cross-sectional study analyzing 981 adults aged 21–69 years with low 10-year cardiovascular risk (Singapore modified Framingham risk score) not taking antihypertensive medications.
Recruitment conducted in public and clinic settings using convenience sampling in Singapore.
Blood pressure evaluated using structured questionnaires, office blood pressure (BP) measurements, and 24-hour ambulatory blood pressure monitoring (ABPM) devices.
Hypertension was identified in 25.5% (250/981) of participants by office BP, 22.7% (223/981) by 24-hour ABPM, and 38.5% (378/981) across any ABPM diagnostic criteria.
Nocturnal hypertension was the most frequent phenotype at 36.1% (354/981), while a non-dipping BP pattern occurred in 59.7% (586/981), masked hypertension in 19.4% (190/981), daytime hypertension in 17.4% (171/981), and white-coat hypertension in 6.5% (64/981).
Nocturnal hypertension was significantly associated with age 40–60 years (aOR 1.27), age 60 years or older (aOR 1.26), male sex (aOR > 1.16), overweight status (aOR 1.13), and obesity (aOR 1.25).

Study Design

Type

Cross-Sectional (n=981)

Structured PICO

P

Population

981 adults aged 21 to 69 years without a history of hypertension and with low 10-year cardiovascular risk, evaluated cross-sectionally in an urban Singaporean setting.

O

Outcome

Prevalence of hypertension phenotypes (including nocturnal hypertension, white-coat hypertension, daytime hypertension, masked hypertension, and circadian BP patterns) measured via office BP and 24-hour ambulatory BP monitoring (ABPM)surrogate

Limitations

Cross-sectional design cannot establish causality or temporality.
Convenience sampling may have introduced selection bias, limiting generalizability.
Cohort was predominantly of Chinese ethnicity (91.2%) and highly educated, not fully representing Singapore's national demographics.
Lack of data on key potential confounders such as dietary sodium intake and obstructive sleep apnea.
Office hypertension was defined using a single office BP reading, potentially introducing misclassification.

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Implication

A substantial proportion of adults with low cardiovascular risk exhibit nocturnal hypertension (36.1%), masked hypertension (19.4%), and non-dipping patterns (59.7%), suggesting standard office BP may underdiagnose risk in this population.

Abstract

Background Global reports on hypertension phenotypes exist, but population‑based evidence remains limited. A significant gap also persists in understanding these phenotypes within multi‑ethnic urban populations. Thus, this study aimed to determine the prevalence of hypertension phenotypes and their associated factors in a low-risk population in Singapore. Methods The cross-sectional study analysed data from 981 adults aged 21–69 years with a low 10-year cardiovascular risk (based on the 2023 Singapore modified Framingham risk score) and not on any antihypertensives. Participants were recruited from public or clinic settings using convenience sampling. Following consent, participants completed clinical examinations and investigations using structured questionnaires and validated instruments, such as office BP and 24-hour ambulatory BP monitoring (ABPM) devices. Results The mean age of the participants was 45.5 years (SD 11.8 years). Most were females (51.6%) and of Chinese ethnicity (91.2%). Normal body mass index (BMI) and waist circumference were observed in 47.0% and 60.7% of the cohort, respectively. Lifestyle data revealed that most participants were nonsmokers (90.9%) and engaged in physical activity (81.3%). The prevalence of hypertension was 25.5% by office BP and 22.7% by 24-hour ABPM, with 38.5% diagnosed via any ABPM target. Nocturnal hypertension (NH) was the most prevalent hypertension phenotype (36.1%), while white-coat hypertension had the lowest prevalence (6.5%). Daytime hypertension and masked hypertension (MH) were observed in 17.4% and 19.4% of participants, respectively. A non-dipping (ND) BP pattern was identified in 59.7% of the cohort. Conclusion This study revealed a high prevalence of NH and ND, with MH emerging as the next most common phenotype in a low-risk, urban Singaporean population. These findings support the potential role of ABPM to unmask hypertension phenotypes. Longitudinal follow up of this cohort could determine their prognostic significance and implications for cardiovascular risk stratification.

Discussion

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Cite This Study

Moosa et al. (2026) conducted a cross-sectional in Hypertension (Phenotypes) (n=981). Ambulatory blood pressure monitoring (ABPM) was evaluated on Prevalence of nocturnal hypertension. In a cohort of adults with low cardiovascular risk, 38.5% were diagnosed with hypertension via ambulatory monitoring, with nocturnal hypertension being the most prevalent phenotype at 36.1%.

synapsesocial.com/papers/6ad0b8f43983294737c0c51a https://doi.org/10.1186/s12889-026-29454-y

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Prevalence of hypertension phenotypes in an urban population with low cardiovascular risk in Singapore: a cross-sectional study

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Prevalence of hypertension phenotypes in an urban population with low cardiovascular risk in Singapore: a cross-sectional study

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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