Does 24-hour ambulatory blood pressure monitoring improve the diagnosis and control of masked hypertension compared to in-office measurement?
Highlights the critical role of 24-hour ambulatory and home blood pressure monitoring in identifying and managing masked hypertension to prevent target organ damage.
Masked hypertension, which is present when in-office normotension translates to out-of-office hypertension, is present in a surprisingly high percentage of untreated persons and an even higher percentage of patients after beginning antihypertensive medication. Not only are persons with prehypertension more likely to have masked hypertension than those with optimal blood pressure (BP), but also they frequently develop target organ damage prior to transitioning to sustained hypertension. Furthermore, the frequency of masked hypertension is high in individuals of African inheritance and in the presence of increased cardiovascular risk factors and disease states, such as diabetes and chronic renal failure. Nocturnal hypertension and non-dipping may be early markers of masked hypertension. Twenty-four hour ambulatory BP monitoring (ABPM), which can detect nighttime and 24 h elevated BP, remains the gold standard for diagnosing masked hypertension. Almost one-third of treated patients with masked hypertension remain as 'masked uncontrolled hypertension', and it becomes important, therefore, to use ABPM (and supplemental home BP monitoring) for the effective diagnosis and control of hypertension.
“Masked hypertension is there; it takes a little extra work to find it, and when present, it disturbs that comfortable feeling of 'That is one well-controlled hypertensive patient.' Most surprising is it is not limited to people with office-based hypertension. It is a phenomenon throughout the population. People on no drugs thought to be 'normotensive' who have elevated BP outside the office also have additional risk from that out-of-office [BP] elevation.”
Franklin et al. (2016) studied this question.