Masked hypertension

Česká verzia

Authors: J. Widimský ¹; M. Sachová ²
Authors place of work: Klinika kardiologie IKEM, Praha, přednosta doc. MUDr. Josef Kautzner, CSc., FESC ¹; Servier Praha ²
Published in the journal: Vnitř Lék 2005; 51(6): 699-703
Category: Reviews

Summary

The term masked hypertension means the hypertension found in daily ambulatory blood pressure measurements (mean BP ≥ 135 and/or ≥ 85 mm Hg) accompanied by normal values of casual blood pressure (BP < 140 and < 90 mm Hg). Home blood pressure should be measured 2x daily over 7 days in the week, whereas the first day measurements are not taken into account as the blood pressure is usually higher the first day. In the diagnosis of hypertension it is possible to meet following groups of patients: a) real hypertension - hypertension at doctor's office and hypertension at home +; b) real normotension – normal BP at doctor's office and at home +; c) white coat hypertension – hypertension at doctor’s office, normal BP at home and d) masked hypertension – normal BP at doctor's office but hypertension at home. Masked hypertension was repeatedly found by the method of daily ambulatory BP monitoring. According to recent studies the home blood pressure measurements provide more precise information of cardiovascular risk for patient than casual pressure. Prognosis of a masked hypertension is worse than a prognosis of a white coat hypertension. Masked hypertension is more frequently accompanied by increased left ventricular mass and by more frequent incidence of atherosclerotic plaques in carotids. Prognosis of a masked hypertension is getting near to a prognosis of an uncontrolled hypertension. Blood pressure measured at home is also substantially better risk predictor of cerebral vascular event than casual blood pressure. On finding of masked hypertension during home blood pressure measurements it is necessary to confirm once more the incidence of masked hypertension first of all. Definitive confirmation of masked hypertension then gives 24-hour blood pressure monitoring. However home blood pressure measurements are essentially important for the detection of masked hypertension. In agreement with the guidelines of European society of hypertension we should think about masked hypertension in patients, which have normal pressure at some time, increased pressure at another time, further in patients with normal BP or high normal BP, where we find signs of left ventricular hypertrophy, in persons with family history of hypertension in both parents, in patients with multiple risk factors for cardiovascular diseases and maybe in diabetic patients.

Key words:
masked hypertension – home blood pressure measurements

Zdroje

1. O’Brien E, Asmar R, Beilin L et al on behalf of the European Society of Hypertension: Recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens 2003; 21: 821–848.

2. Bobrie G, Genés N, Vaur L et al. Is „isolated home“ hypertension as opposed to „isolated office“ hypertension a sign of greater cardiovascular risk? Arch Intern Med 2001; 161: 2205–2211.

3. Widimský J, Potocka AC, Balažovjech I et al. Přínos domácího měření krevního tlaku k léčbě hypertenze. Cor Vasa 1998; 40: 331–337.

4. Pickering TG, Davidson K, Gerin W et al. Masked hypertension. Hypertension 2002; 40: 795–796.

5. Mancia G, Sega R, Bravi C et al. Ambulatory blood pressure normality: results from the PAMELA study. J Hypertens 1995; 13: 1377–1390.

6. Wing LMH, Brown MA, Beilin LJ et al on behalf of the ANBP2 Management Committee and Investigators. Reverse white-coat hypertension in older hypertensives. J Hypertens 2002; 20: 639–644.

7. Widimský J, Balažovjech I, Lánská V. Přínos domácího měření tlaku k léčbě hypertenze v praxi všeobecných lékařů. Vnitř Lék 1999; 45(10): 569–577.

8. Mancia G, Zanchetti A, Agabiti-Rosei E et al for the SAMPLE Study Group. Ambulatory blod pressure is superior to clinic blood pressure in predicting treatment-induced regression of left ventricular hypertrophy. Circulation 1997; 95: 1464–1470.

9. Liu JE, Roman MJ, Pini R et al. Cardiac and arterial target organ damage in adults with elevated ambulatory and normal office blood pressure. Ann Intern Med 1999; 131: 564–572.

10. Sega R, Trocino G, Lanzarotti A et al. Alterations of cardiac structure in patients with isolated office, ambulatory, or home hypertension: data from the general population (Pressione Arteriose Monitorate E Loro Associazioni – PAMELA study). Circulation 2001; 104: 1385–1392.

11. Bobrie G, Chatellier G, Genes N et al. Cardiovascular prognosis of „masked hypertension“ detected by blood pressure self-measurement in elderly treated hypertensive patients. JAMA 2004; 291: 1342–1349.

12. Ohkubo T, Asayama K, Kikuya M et al. How many times should blood pressure be measured at home for better prediction of stroke risk? 10-year follow-up results from the Ohasama study. J Hypertens 2004; 22: 1099–1104.

13. O’Brien E, Beevers G, Lip GHY. ABC of hypertension. Part IV. Automated sphygmomanometry: self blood pressure measurement. Br Med J 2001; 322: 1167–1170.

14. O’Brien E, Atkins N, Staessen J. State of the market: a review of ambulatory blood pressure monitoring devices. Hypertension 1995; 26: 835–842.

15. White WB. Blood pressure monitoring in cardiovascular medicine and therapeutics. Totowa (New Jersey): Humana Press 2001.

16. Grassi G, Foglia G, Dell’Oro R et al. Reproducibility of home blood pressure monitoring by a new oscillometric wrist device. J Hypertens 2001; 19(Suppl 2): 22–23.

17. Uen E, Weisser B, Wieneke P et al. Evaluation of the performance of a wrist blood pressure measuring device with a position sensor compared to ambulatory 24-hour blood pressure measurements. Am J Hypertens 2002; 9: 787–792.

18. Reims H, Kjeldsen S, Mancia G. Home blood pressure monitoring. Eur Soc Hypertens Scient Newsletter 2002; No 12

19. Ohkubo T, Imai Y, Tsuji I et al. Home blood pressure measurement has a stronger predictive power for mortality than dose screening blood pressure measurement: a population-based observation in Ohasama, Japan. J Hypertens 1998; 16: 971–975.

20. Staessen J, Thijs L and the participants of the First International Consensus Conference on Blood Pressure Self-Measurement. Development of diagnostic thresholds for automated self-measurement of blood pressure in adults. Blood Press Monit 2000; 5: 101–109.