Can home blood pressure checks miss hidden hypertension that ambulatory monitoring detects?

Details

Guidelines recommend measuring blood pressure (BP) outside the clinic to identify masked hypertension (MHT): blood pressure in the hypertensive range outside the clinic despite clinic measurements not being in that range. This study aimed to determine how much ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) overlap in detecting MHT.

In an observational analysis, researchers used data from 333 community-dwelling adults in the IDH study (Improving the Detection of Hypertension). Participants were not taking antihypertensive medication and had clinic BP <140/90 mm Hg.

“Any MHT” on ABPM meant having daytime MHT (mean daytime BP ≥135/85 mm Hg), 24-hour MHT (mean 24-hour BP ≥130/80 mm Hg), or nighttime MHT (mean nighttime BP ≥120/70 mm Hg). Home MHT meant mean BP ≥135/85 mm Hg on HBPM.

The prevalence was 25.8% for any MHT and 11.1% for home MHT. Among participants with MHT on either ABPM or HBPM, 29.5% had MHT on both methods, 61.1% had MHT only on ABPM, and 9.4% had MHT only on HBPM.

After multivariable adjustment, participants with MHT on both methods had a higher left ventricular mass index than participants without MHT on either method: mean difference [standard error], 12.7 [2.9] g/m², P <0.001. Those with MHT only on ABPM also had a higher left ventricular mass index: mean difference [standard error], 4.9 [2.1] g/m², P =0.022. In contrast, those with MHT only on HBPM did not have an increased left ventricular mass index: mean difference [standard error], −1.9 [4.8] g/m², P =0.693.

The authors conclude that these data suggest ABPM will detect many individuals with MHT who have increased cardiovascular disease risk.