What Is the Significance of Masked Hypertension Versus Incident Hypertension in Blacks?
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See related article, pp 220–226
Treatment-naive masked hypertension has been defined as discordant in-office normotension (<140/<90 mm Hg) versus out-of-office hypertension (≥135/85 mm Hg) for either home blood pressure (BP) monitoring (HBPM) or ambulatory BP monitoring (ABPM) of daytime ABPM (≥135/85 mm Hg), night-time ABPM (≥120/70 mm Hg), 24-hour ABPM (≥130/80 mm Hg), or a combination of these out-of-office BP subtypes. Masked hypertension may be a precursor of sustained hypertension, remain masked hypertension for a prolonged period of time, and occasionally revert to normotension.1 However, there are at least 5 other aspects of masked hypertension of clinical importance: (1) it has been considered an intermediate phenotype between sustained normotension and sustained hypertension, which most frequently arises from antecedent high-normal BP (130–139/85–89 mm Hg), less frequently from antecedent normal BP (120–129/80–84 mm Hg); and least frequently from antecedent optimal BP (<120/<80 mm Hg)1 (note that normal and high-normal BP when combined are called prehypertension); (2) it frequently is associated with hypertensive target organ damage even without progressing to hypertension, perhaps because of increased pressure burden in daily life, and despite a long-dormant period before transitioning to sustained hypertension1; (3) it has been associated with many cardiometabolic abnormalities, including obesity, metabolic syndrome, diabetes mellitus, obstructive sleep apnea, and chronic renal disease1; (4) it frequently has been associated with nocturnal hypertension and impaired nocturnal dipping of BP—a particularly high-risk phenotype2; and (5) there is an especially high prevalence of masked hypertension in people of African descent, approaching 30% to 50% in some series.3–6
It is with this background that the present investigators used ABPM to define …