Reproducibility of masked hypertension among adults 30 years or older

Abstract

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.

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

“…Single-drug therapy reduced Relevant 2° endpoint: Active treatment also reduced the risk of total major vascular events (26% [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]). There were similar reductions in the risk of stroke in hypertensive and nonhypertensive subgroups (all p<0.01).…”

An Update on Masked Hypertension

“…A separate study by Viera et al found daytime ABPM and HBPM to agree 72.1% of the time (kappa 0.36) for diagnosing masked hypertension. (29) As different diagnoses can be reached when using alternate out-of-clinic BP measurement modalities, the preferred method for clinical practice remains uncertain.…”

Ambulatory Blood Pressure Phenotypes and the Risk for Hypertension

“…We are aware of no studies that examined the risk of sustained hypertension associated with nocturnal hypertension or across strata of ambulatory BP variability. Studies that have used home BP instead of ambulatory BP monitoring have found similar results, although it is not certain that these methods are interchangeable for identifying out-of-office BP phenotypes [28]. …”