Short-Term Reproducibility of Masked Hypertension Among Adults Without Office Hypertension

Laura P. Cohen, Joseph E. Schwartz, Daniel N. Pugliese, D. Edmund Anstey, Jessica P. Christian, Stephanie Jou, Paul Muntner, Daichi Shimbo, Natalie A. Bello

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

The 2017 American College of Cardiology/American Heart Association blood pressure (BP) Hypertension Clinical Practice Guidelines recommends ambulatory BP monitoring to detect masked hypertension. Data on the short-term reproducibility of masked hypertension are scarce. The IDH study (Improving the Detection of Hypertension) enrolled 408 adults not taking antihypertensive medication from 2011 to 2013. Office BP and 24-hour ambulatory BP monitoring were performed on 2 occasions, a median of 29 days apart. After excluding participants with office hypertension (mean systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg), the analytical sample included 254 participants. Using the κ statistic, we evaluated the reproducibility of masked awake hypertension (awake systolic/diastolic BP ≥130/80 mm Hg) defined by the 2017 BP guideline thresholds, as well as masked 24-hour (24-hour systolic/diastolic BP ≥125/75 mm Hg), masked asleep (asleep systolic/diastolic BP ≥110/65 mm Hg), and any masked hypertension (high awake, 24-hour, and asleep BP). The mean (SD) age of participants was 38.0 (12.3) years and 65.7% were female. Based on the first and second ambulatory BP recordings, 24.0% and 26.4% of participants, respectively, had masked awake hypertension. The κ statistic (95% CI) was 0.50 (0.38-0.62) for masked awake, 0.57 (0.46-0.69) for masked 24-hour, 0.57 (0.47-0.68) for masked asleep, and 0.58 (0.47-0.68) for any masked hypertension. Clinicians should consider the moderate short-term reproducibility of masked hypertension when interpreting the results from a single ambulatory BP recording.

Original languageEnglish (US)
Pages (from-to)1169-1175
Number of pages7
JournalHypertension
Volume76
Issue number4
DOIs
StatePublished - Oct 1 2020
Externally publishedYes

Keywords

  • American Heart Association
  • blood pressure monitoring
  • guideline
  • masked hypertension
  • statistics

ASJC Scopus subject areas

  • Internal Medicine

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