Predictors of Masked Hypertension Among Treated Hypertensive Patients: An Interesting Association With Orthostatic Hypertension

Barochiner, Jessica; Cuffaro, Paula E.; Aparicio, Lucas S.; Alfie, José; Rada, Marcelo A.; Morales, Margarita S.; Galarza, Carlos; Waisman, Gabriel

doi:10.1093/ajh/hpt036

Cited by 35 publications

(39 citation statements)

References 34 publications

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“…In fact, PAD is not only related to established hypertension but has also been found to be associated with masked hypertension, ie, normal office BP readings but elevated out-of-office BP readings 99,100…”

Section: Challenges Associated With the Management Of Pad In Womenmentioning

confidence: 99%

Challenges associated with peripheral arterial disease in women

Barochiner¹,

Aparicio²,

Waisman³

2014

VHRM

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Peripheral arterial disease (PAD) is an increasingly recognized disorder that is associated with functional impairment, quality-of-life deterioration, increased risk of cardiovascular ischemic events, and increased risk of total and cardiovascular mortality. Although earlier studies suggested that PAD was more common in men, recent reports based on more sensitive tests have shown that the prevalence of PAD in women is at least the same as in men, if not higher. PAD tends to present itself asymptomatically or with atypical symptoms more frequently in women than in men, and is associated with comorbidities or situations particularly or exclusively found in the female sex, such as osteoporosis, hypothyroidism, the use of oral contraceptives, and a history of complications during pregnancy. Fat-distribution patterns and differential vascular characteristics in women may influence the interpretation of diagnostic methods, whereas sex-related vulnerability to drugs typically used in subjects with PAD, differences in risk-factor distribution among sexes, and distinct responses to revascularization procedures in men and women must be taken into account for proper disease management. All these issues pose important challenges associated with PAD in women. Of note, this group has classically been underrepresented in research studies. As a consequence, several sex-related challenges regarding diagnosis and management issues should be acknowledged, and research gaps should be addressed in order to successfully deal with this major health issue.

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Section: Challenges Associated With the Management Of Pad In Womenmentioning

confidence: 99%

Challenges associated with peripheral arterial disease in women

Barochiner¹,

Aparicio²,

Waisman³

2014

VHRM

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“…Although this association between orthostatic hypertension and masked hypertension has been reported in hypertensive patients, 7 it is notable that the subjects in the study by Tabara et al were healthy individuals, and the results illustrate an association between orthostatic BP changes and awake BP obtained by ABPM. The findings by Tabara et al clearly demonstrate that orthostatic hypertension has a common pathophysiology with masked hypertension.…”

mentioning

confidence: 54%

The measurement of orthostatic blood pressure as a screening tool for masked hypertension with abnormal circadian blood pressure rhythm

2016

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I t has been repeatedly noted that cardiovascular events often occur in individuals who have never been diagnosed with hypertension. These events occur in part because it is difficult to identify masked hypertension in untreated individuals. However, the elevation of subclinical blood pressure (BP) in individuals with masked hypertension can exacerbate damage to the hypertensive target organ and result in an overt cardiovascular event. 1,2 Although home BP measurements in the morning and evening are recommended by the Japanese Society of Hypertension 2014 guidelines, 3 home BP monitoring may not always detect a BP elevation if the BP is elevated at times other than the time of the home BP measurement (for example, other than in the morning and evening). Ambulatory BP monitoring (ABPM) is thus useful to detect masked hypertension because it provides BP data at many more time points compared with home BP monitoring.Physicians should try to identify individuals who are at a high risk for masked hypertension, with the goal of preventing cardiovascular events in this population. The reported characteristics of masked hypertension are male sex, middle age, smoking, regular alcohol drinking and high daytime physical activity; 4 in fact, such populations show increased arterial damage. 5 However, an effective method for identifying masked hypertension has not yet been established.In this issue of Hypertension Research, Tabara et al. 6 demonstrate a relationship between masked hypertension and orthostatic hypertension in healthy individuals. Although this association between orthostatic hypertension and masked hypertension has been reported in hypertensive patients, 7 it is notable that the subjects in the study by Tabara et al. were healthy individuals, and the results illustrate an association between orthostatic BP changes and awake BP obtained by ABPM. The findings by Tabara et al. clearly demonstrate that orthostatic hypertension has a common pathophysiology with masked hypertension. However, the mechanisms underlying the link between orthostatic hypertension and masked hypertension are not clearly understood.One possible mechanism underlying this link is enhanced sympathetic nervous system activity. It was observed that the plasma noradrenaline level was increased after standing in patients with orthostatic hypertension. 8,9 This abnormality in the sympathetic nervous system would cause an abnormal circadian BP rhythm, such as a morning BP surge, stress hypertension or exercise-induced hypertension, and these conditions may be expressed as masked hypertension. In a study by Tabara et al., the average awake BP values measured by ABPM and office BP are used to define masked hypertension. The masked hypertension observed in that study would thus include morning hypertension-type masked hypertension. Considering past and present findings, it is apparent that masked hypertension, orthostatic hypertension and the morning BP surge are closely related to one another 9,10 ( Figure 1).According to the results reported by Taba...

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“…Yet, because it is implausible to perform routine 24‐hour ABPM in the general population, identification of individuals at high risk for masked hypertension may enable performance of selective 24‐hour ABPM in order to identify this population. Various studies have tried to characterize patients at risk for masked hypertension and factors associated with this phenomenon include age, SBP, and markers of atherosclerosis such as the presence of peripheral arterial disease, diabetes, left ventricular hypertrophy, and smoking …”

Section: Discussionmentioning

confidence: 99%

“…Therefore, ABPM should be performed only in normotensive patients who are likely to have masked hypertension. Patients with evidence of target organ damage or with diabetes mellitus and those with occasional elevated BP readings, a history of peripheral vascular disease, or orthostatic hypertension are at a high risk for masked hypertension …”

mentioning

confidence: 99%

“…Patients with evidence of target organ damage or with diabetes mellitus and those with occasional elevated BP readings, a history of peripheral vascular disease, or orthostatic hypertension are at a high risk for masked hypertension. 6,7 Exaggerated BP response to exercise (ExBPR) in normotensive patients has been suggested to predict the development of frank hypertension [8][9][10][11] and has been found to be associated with target organ damage, particularly left ventricular hypertrophy. 12 However, some studies failed to show an association between ExBPR and the development of hypertension and target organ damage or CV disease.…”

mentioning

confidence: 99%

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Exaggerated Blood Pressure Response to Exercise Is Not Associated With Masked Hypertension in Patients With High Normal Blood Pressure Levels

Grossman

Cohen

Shemesh

et al. 2014

J of Clinical Hypertension

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The association between exaggerated blood pressure (BP) response to exercise (ExBPR) and “masked hypertension” is unclear. Medical records of patients with high‐normal BP who were evaluated in the Chaim Sheba Screening Institute Ramat Gan, Israel, during the years 2002–2007 and referred for 24‐hour ambulatory BP monitoring (ABPM) and exercise test were reviewed. Data on exercise tests performed in the preceding 5 years were retrieved. Reproducible ExBPR was defined when it was recorded at least twice. BP levels on 24‐hour ABPM were compared between patients with a normal BP response and those with an ExBPR (systolic BP ≥200 mm Hg). Sixty‐nine normotensive patients with high normal BP levels were identified. ExBPR was recorded in 43 patients and was reproducible in 28. BP levels on 24‐hour ABPM were similar in patients with and without ExBPR. In patients with high‐normal BP levels, ExBPR is not associated with masked hypertension.

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Predictors of Masked Hypertension Among Treated Hypertensive Patients: An Interesting Association With Orthostatic Hypertension

Abstract: Easily measurable parameters such as age, office systolic BP, history of PAD, and OHT may help to detect a population at risk of MH that would benefit from home BP monitoring.

Cited by 35 publications

References 34 publications

Challenges associated with peripheral arterial disease in women

Challenges associated with peripheral arterial disease in women

The measurement of orthostatic blood pressure as a screening tool for masked hypertension with abnormal circadian blood pressure rhythm

Exaggerated Blood Pressure Response to Exercise Is Not Associated With Masked Hypertension in Patients With High Normal Blood Pressure Levels

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