The Dangers Of Masked Hypertension
January 23, 2014

Elevated Blood Pressure While At Home Increases Heart Attack Risk

Lee Rannals for - Your Universe Online

An elevated blood pressure (BP) is a sign of being at-risk for a heart attack, but not all measurements show a high BP while at the doctor.

Researchers from the University of Leuven, Belgium found that patients who had a normal BP in clinic, but elevated BP when they measured at home, were at a higher risk of death and cardiovascular events compared to those who always have a normal BP. This type of behavior is what is known in the medical community as masked hypertension.

Jan A Staessen and colleagues looked at individual patient data meta-analysis of studies published before July 2013, which included 5,008 participants. Results showed that self-measured home BP was lower on average than clinic BP, but 569 patients had masked hypertension when measured at home compared to the clinic.

After an average of 8.3 years of follow-up, 522 participants died and 414 had a fatal or nonfatal cardiovascular event. The findings showed that patients with masked hypertension were more likely to die than those patients with optimal blood pressure.

Patients in the study with masked hypertension were more likely to be male, to smoke, to have diabetes mellitus, a history of cardiovascular disease, and to be older and obese.

"The key finding of our current study is that home blood pressure substantially refines risk stratification at levels of the conventional blood pressure that are presumably associated with no or only mildly elevated risk. In contrast, in severe hypertension, the self-measured home blood pressure did not improve the prediction of death or cardiovascular complications,” the authors wrote in the journal PLOS Med. “Consequently, we suggest that in individuals at risk for masked hypertension, home blood pressure monitoring should be included in the strategy of primary prevention of cardiovascular complications.”

The team said properly designed clinical trials are required to demonstrate that identification and treatment of masked hypertension leads to a reduction of cardiovascular complications and is cost-effective.

Mark Caulfield, from The London School of Medicine and Dentistry, UK, wrote in an accompanying article that this study is important because it could refine risk stratification in normotensive people with optimal, normal or high blood pressure based on clinic BP monitoring who are not conventionally treated.

“In addition, HBPM [home BP monitoring] showed improved stratification of risk in those with masked hypertension who have normal clinic blood pressure but on HBPM or ABPM [ambulatory BP monitoring] have periods of elevated BP that may be benefit from treatment,” Caulfield wrote. “With a growing burden of high blood pressure and affordable devices, HBPM could be used to diagnose high blood pressure and help decide whom to treat. It empowers patients to take on a role in assessment of their blood pressure.”

He added that smartphones could be used to help avoid travel and save time for the healthcare team if they conduct remote consultations. People can use these devices to upload their BP measurement from home, while also displaying blood pressure trends over time.