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Management of Masked Hypertension: Why Are We Still Sitting on the Fence?

See related article, pp 1475–1482 

In this issue of Hypertension , the Jackson Heart Study in an African-American cohort reported high prevalence of masked hypertension (MH; 30% of those with low office blood pressure [BP] measurements [OBPM]) and much higher in subjects with worse cardiovascular risk factor profile versus those with more healthy profile.1 Higher prevalence of MH with poor cardiovascular score was found in both untreated subjects and treated hypertensives. Interestingly, because 21% of the participants had elevated OBPM (and were excluded), >50% were treated for hypertension, and 30% had MH (60% treated), fewer than 30% were truly normotensives (low office and ambulatory BP).1 As hypertension is known to be more common in African-Americans and to cluster with other cardiovascular risk factors, the high prevalence of MH in the Jackson Heart Study and its association with high cardiovascular risk profile suggest that MH behaves as—if not is—sustained hypertension. The authors concluded that lifestyle modification would benefit subjects with MH, which is well established also for sustained hypertension.

MH was first introduced as a clinically relevant phenotype of hypertension by Thomas Pickering et al2 in 2002. This is interesting by itself, as such cases always …