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(Hypertension. 2005;45:481.)
© 2005 American Heart Association, Inc.

Editorial Commentaries

Unmasking Hypertension

Eoin O’Brien

From Cardiovascular Pharmacology, Institute of Biopharmaceutical Sciences, Royal College of Surgeons in Ireland, and ADAPT Centre, Beaumont Hospital, Dublin, Ireland.

Correspondence to Eoin O’Brien, Professor of Cardiovascular Pharmacology, Royal College of Surgeons in Ireland, Blood Pressure Unit, Dublin 9, Ireland. E-mail eobrien@iol.ie

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Conventional blood pressure measurement using a mercury sphygmomanometer and stethoscope has clearly shown a strong relationship between blood pressure and cardiovascular risk,¹ and the technique has also demonstrated the benefit of lowering high blood pressure with antihypertensive medication.² However, despite these merits, conventional measurement has been criticized on many counts that have included inaccuracy and the banning of mercury on environmental grounds.³ The technique has come under further pressure from national bodies recommending measurement with automated techniques to provide profiles of blood pressure behavior outside the medical environment.^4,5 Among such techniques, ambulatory blood pressure measurement (ABPM) is now increasingly recognized as being indispensable to the diagnosis and management of hypertension.⁶ Quite apart from the potential for ABPM to predict outcome more accurately than conventional blood pressure measurement,⁴ the technique has contributed significantly to our understanding of hypertension by revealing or "unmasking" blood pressure phenomena that were not readily apparent using traditional techniques of measurement in clinical practice. These have included the dipping and nondipping patters of nocturnal blood pressure,⁷ and white-coat hypertension,⁸ to which must now be added masked hypertension, a condition in which subjects classified as normotensive by conventional office or clinic measurement are hypertensive with ABPM or self-measurement.⁹ White-coat hypertension has also been called "isolated clinic hypertension," and "isolated ambulatory hypertension," "reverse white-coat hypertension," "undetected ambulatory hypertension," and "white-coat normotension" have been proposed as alternative terms for masked hypertension.⁹ These names are unlikely to replace the "catchy" appeal of the original nomenclature, although "isolated clinic hypertension" and "isolated . . . [Full Text of this Article]

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