Masked hypertension

Czech version

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

Overview

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

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