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

Masked hypertension (MH) entails an increased cardiovascular risk. Therefore, it is important to identify those individuals who would benefit the most from out-of-office blood pressure (BP) measurement. We sought to determine the prevalence and identify predictors of MH among adult hypertensive patients under treatment. Treated hypertensive patients aged 18 years underwent office (duplicate sitting and standing BP in 1 visit) and home BP measurements (duplicate measurements for 4 days in the morning, afternoon, and evening; at least 16 measurements) and completed a questionnaire regarding risk factors and history of cardiovascular disease. MH was defined as normal office BP (< 140/90mm Hg) with elevated home BP (135/85mm Hg, average of all readings discarding first day measurements). Patients with a systolic BP rise upon standing 5mm Hg were considered to have orthostatic hypertension (OHT). Variables indentified as relevant predictors of MH were entered into a multivariable logistic regression analysis model. Three hundred and four patients were included (mean age 66.7 13.8; 67.4% women). The prevalence of MH in the whole population was 12.4% and was 20.9% among patients with office-controlled hypertension. Factors independently associated with MH were age (odds ratio (OR) 1.08, 95% confidence interval (CI) 1.031.14), high-normal office systolic BP (OR 5.61, 95% CI 1.3922.57), history of peripheral artery disease (PAD) (OR 8.83, 95% CI 1.551.84), moderate alcohol consumption (OR 0.08, 95% CI 0.010.73), and OHT (OR 3.65, 95% CI 1.27 to 10.51). 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.