Objective Masked hypertension (MH) refers to non-elevated office blood pressure (BP) with elevated out-of-office BP, but its reproducibility has not been conclusively established. We examined one-week reproducibility of MH by home BP monitoring (HBPM) and ambulatory BP monitoring (ABPM). Methods We recruited 420 adults not on BP-lowering medication with recent clinic BP between 120/80 and 149/95 mm Hg. For main comparisons, participants with office average <140/90 mm Hg were considered to have MH if awake ABPM average was ≥135/85 mm Hg; they were considered to have MH by HBPM if the average was ≥135/85 mm Hg. Percent agreements were quantified using kappa. We also examined prevalence of MH defined as office average <140/90 mm Hg with 24-hour ABPM average ≥130/80 mm Hg. We conducted sensitivity analyses using different threshold BP levels for ABPM-office pairings and HBPM-office pairings for defining MH. Results Prevalence rates of MH based on office-awake ABPM pairings were 44% and 43%, with agreement of 71% (kappa=0.40; 95% CI 0.31–0.49). MH was less prevalent (15% and 17%) using HBPM-office pairings, with agreement of 82% (kappa=0.30; 95% CI 0.16–0.44), and more prevalent when considering 24-hour average (50% and 48%). MH was also less prevalent when more stringent diagnostic criteria were applied. Office-HBPM pairings and office-awake ABPM pairings had fair agreement on MH classification on both occasions, with kappas of 0.36 and 0.30. Conclusions MH has fair short-term reproducibility, providing further evidence that for some people, out-of-office BP is systematically higher than when measured in the office setting.

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