Hypertension-mediated organ damage in masked hypertension

Abstract

Objectives: Masked hypertension -a blood pressure (BP) phenotype characterized by a clinic BP in the normal range but elevated BP outside the office -is associated with early hypertension-mediated organ damage. This study examined early target organ manifestations of masked hypertension diagnosed by home (HBPM) and ambulatory (ABPM) BP monitoring.Methods: Left ventricular (LV) structure and diastolic function measured by echocardiography, microalbuminuria, and coronary artery calcification were evaluated in 420 patients with high clinic BP (SBP 120-150 mmHg or DBP 80-95 mmHg). Evidence of hypertension-mediated organ damage was compared in patients with sustained normotension, masked hypertension, and sustained hypertension based on measurements by HBPM, daytime ABPM, and 24-h ABPM. Results:The 420 participants averaged 48 (12) [mean (SD)] years of age; the average clinic BP was 130 (13)/81 (8) mmHg. In individuals with masked hypertension diagnosed by HBPM, indexed LV mass, relative wall thickness, and e 0 and E/e 0 (indices of LV relaxation), were generally intermediate between values observed in normotensives and sustained hypertensive patients, and were significantly greater in masked hypertension than normotensives. Similar trends were observed when masked hypertension was diagnosed by ABPM but a diagnosis of masked hypertension was not as reliably associated with LV remodeling or impaired LV relaxation in comparison to normotensives. There were trends towards greater likelihoods of detectable urinary microalbumin and coronary calcification in masked hypertension than in normotensives. Conclusion:These results support previous studies demonstrating early hypertension-mediated organ damage in patients with masked hypertension, and suggest that HBPM may be superior to ABPM in identifying patients with masked hypertension who have early LV remodeling and diastolic LV dysfunction.

Masked hypertension in a middle-aged population and its relation to manifestations of vascular disease

“…PWV is a noninvasive surrogate marker of arterial stiffness, which has previously been associated with masked hypertension and cardiovascular events [9,11,26]. The association between masked hypertension and increased CACS has previously been suggested as a trend, but not confirmed as significant [27]. As for the carotid arteries, previous studies have shown an association with increased carotid intima thickness [11], but to the best of our knowledge, no previously published study has shown an association with the presence of carotid artery plaques.…”

Home Blood Pressure in Health and Disease

“…Masked hypertension, regardless of method used for diagnosis, is cross-sectionally associated with smoking, diabetes, and history of CVD (168,170,171,179,190). A trend, albeit not significant, has been found towards higher prevalence of coronary artery calcifications (191). Masked hypertension diagnosed using home BP is also associated with older age, higher BMI, higher cholesterol, and increased carotid intima-media thickness (170,171,192); MH diagnosed using ambulatory BP is also associated with younger age, obstructive sleep apnea, left ventricular hypertrophy, chronic kidney disease, and BP-lowering medication (168,170,179,190,193,194).…”

“…CACS >100 is associated with an increased risk of CVD and is used by several major guidelines to suggest initiation or consideration of initiation of lipidlowering therapy and in some guidelines also acetylsalicylic acid (299). The association between MH and CACS has previously been suggested as a trend but not found to be significant (191).…”

Full-Arch Implant-Prosthetic Rehabilitation in Patients Affected by Hypertension: A Randomized Clinical Trial at 7 Years Follow-Up

“…Hypertension may affect blood vessels and other organs over time, resulting in a higher risk of heart attack, stroke, kidney impairment, and other medical disorders [5][6][7].…”