Masked hypertension incidence and risk factors in a prospective cohort study

Abstract

Aims

Masked hypertension may affect up to 30% of the general population and is associated with a high cardiovascular disease risk. No previous study has examined the incidence of masked hypertension and its risk factors. The study aim was to determine the incidence of masked hypertension and to examine its related risk factors.

Methods

This is a cohort study including 1836 initially normotensive participants followed up on average for 2.9 years. Blood pressure was measured using Spacelabs 90207. Manual blood pressure was defined as the mean of the first three readings taken at rest. Ambulatory blood pressure was defined as the mean of the next readings recorded every 15 minutes during daytime working hours. Masked hypertension incidence at follow-up was defined as manual blood pressure less than 140 and less than 90 mmHg and ambulatory blood pressure at least 135 or at least 85 mmHg. Generalised estimating equations were used.

Results

The cumulative incidence of masked hypertension was 10.3% and was associated with male gender (relative risk (RR) 1.51, 95% confidence interval (CI) 1.18–1.94), older age (RR_{40–49 years} 1.56, 95% CI 1.16–2.11, RR_{≥50 years} 1.50, 95% CI 1.06–2.10), higher education (RR_college 1.31, 95% CI 1.03–1.65), body mass index (RR_≥27 1.43, 95% CI 1.11–1.85), smoking (RR 1.51, 95% CI 1.09–2.010) and alcohol intake (RR_≥6/week 1.65, 95% CI 1.13–2.03).

Conclusion

The present study is the first to identify risk factors for the incidence of masked hypertension. Current guidelines for hypertension detection recommend ambulatory blood pressure in patients with an elevated blood pressure reading at the clinic. As it is impractical to measure ambulatory blood pressure in all normotensive patients, factors identified in the present study should be considered for the screening of at-risk individuals and for primary prevention of masked hypertension.

Keywords

Masked hypertension risk factors prospective cohort study epidemiology ambulatory blood pressure

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References

Pickering

Eguchi

Kario

. Masked hypertension: a review. Hypertens Res 2007; 30: 479–488.

O'Brien

Asmar

Beilin

et al.

European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens 2003; 21: 821–848.

Franklin

O'Brien

Staessen

. Masked hypertension: understanding its complexity. Eur Heart J 2017; 38: 1112–1118.

Pickering

Davidson

Gerin

et al.

Masked hypertension. Hypertension 2002; 40: 795–796.

Franklin

O'Brien

Thijs

et al.

Masked hypertension: a phenomenon of measurement. Hypertension 2015; 65: 16–20.

Peacock

Diaz

Viera

et al.

Unmasking masked hypertension: prevalence, clinical implications, diagnosis, correlates and future directions. J Hum Hypertens 2014; 28: 521–528.

Fagard

Cornelissen

. Incidence of cardiovascular events in white-coat, masked and sustained hypertension versus true normotension: a meta-analysis. J Hypertens 2007; 25: 2193–2198.

Hansen

Kikuya

Thijs

et al.

Prognostic superiority of daytime ambulatory over conventional blood pressure in four populations: a meta-analysis of 7,030 individuals. J Hypertens 2007; 25: 1554–1564.

Banegas

Ruilope

de la Sierra

et al.

Relationship between clinic and ambulatory blood-pressure measurements and mortality. N Engl J Med 2018; 378: 1509–1520.

10.

Verberk

Thien

de Leeuw

. Masked hypertension, a review of the literature. Blood Press Monit 2007; 12: 267–273.

11.

Trudel

Brisson

Larocque

et al.

Masked hypertension: different blood pressure measurement methodology and risk factors in a working population. J Hypertens 2009; 27: 1560–1567.

12.

McKay

Myers

Bolli

et al.

Masked hypertension: a common but insidious presentation of hypertension. Can J Cardiol 2006; 22: 617–620.

13.

Trudel

Milot

Gilbert-Ouimet

et al.

Effort–reward imbalance at work and the prevalence of unsuccessfully treated hypertension among white-collar workers. Am J Epidemiol 2017; 186: 456–462.

14.

Trudel

Gilbert-Ouimet

Milot

et al.

Cohort profile: the PROspective Quebec (PROQ) study on work and health. Int J Epidemiol 2018; 47: 693a–i.

15.

Cloutier

Daskalopoulou

Padwal

et al.

A new algorithm for the diagnosis of hypertension in Canada. Can J Cardiol 2015; 31: 620–630.

16.

O'Brien

Coats

Owens

et al.

Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British Hypertension Society. BMJ 2000; 320: 1128–1134.

17.

O'Brien

Mee

Atkins

et al.

Accuracy of the SpaceLabs 90207 determined by the British Hypertension Society protocol. J Hypertens 1991; 9: S25–S31.

18.

O'Brien

Asmar

Beilin

et al.

Practice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurement. J Hypertens 2005; 23: 697–701.

19.

Daveluy

Pica

Audet

et al.

Quebec Health and Social Survey, 2nd ed. Québec: Institut de la Statistique du Québec, 2000.

20.

Santé Québec. Et votre coeur, ça va? Rapport de l'Enquête québécoise sur la santé cardiovasculaire 1990. Montréal, Québec: ministére de la Santé et des Services sociaux, gouvernement du Québec, 1994.

21.

Zeger

Liang

. Longitudinal data analysis for discrete and continuous outcomes. Biometrics 1986; 42: 121–130.

22.

SAS Institute Inc. The SAS system for Sun OS, Cary, NC: SAS Institute Inc., 2000.

23.

Skarn

Flaa

Kjeldsen

et al.

High screening blood pressure at young age predicts future masked hypertension: a 17 year follow-up study. Blood Press 2015; 24: 131–138.

24.

Gillis

Sullivan

. Sex differences in hypertension: recent advances. Hypertension 2016; 68: 1322–1327.

25.

Scuteri

Morrell

Orru

et al.

Gender specific profiles of white coat and masked hypertension impacts on arterial structure and function in the Sardinia study. Int J Cardiol 2016; 217: 92–98.

26.

Marmot

Brunner

. Cohort profile: the Whitehall II study. Int J Epidemiol 2005; 34: 251–256.

27.

Trudel

Brisson

Milot

. Job strain and masked hypertension. Psychosom Med 2010; 72: 786–793.

28.

Obara

Ohkubo

Funahashi

et al.

Isolated uncontrolled hypertension at home and in the office among treated hypertensive patients from the J-HOME study. J Hypertens 2005; 23: 1653–1660.

29.

Selenta

Hogan

Linden

. How often do office blood pressure measurements fail to identify true hypertension? An exploration of white-coat normotension. Arch Fam Med 2000; 9: 533–540.

30.

Ishikawa

Kario

Eguchi

et al.

Regular alcohol drinking is a determinant of masked morning hypertension detected by home blood pressure monitoring in medicated hypertensive patients with well-controlled clinic blood pressure: the Jichi Morning Hypertension Research (J-MORE) study. Hypertens Res 2006; 29: 679–686.

31.

Stevens

Truesdale

Katz

et al.

Impact of body mass index on incident hypertension and diabetes in Chinese Asians, American Whites, and American Blacks: the People's Republic of China Study and the Atherosclerosis Risk in Communities Study. Am J Epidemiol 2008; 167: 1365–1374.

32.

McFadden

Brensinger

Berlin

et al.

Systematic review of the effect of daily alcohol intake on blood pressure. Am J Hypertens 2005; 18: 276–286.

33.

Whelton

Carey

Aronow

et al.

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 71: e127–e248.

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