Clinical, psychological characteristics can help identify masked hypertension
MedWire News: Doctors should be alert to classical cardiovascular risk factors such as older age, higher body-mass index (BMI), and diabetes, as well as high-normal office blood pressure (BP) measurements and hypochondria, as signs of potential masked hypertension, Finnish researchers say.
Although home BP measurement can identify individuals with masked hypertension (normal office BP and high out-of-office BP), it is not feasible to measure home BP in all office normotensive individuals, they write in the Journal of Hypertension.
They therefore decided to investigate which clinical and psychological characteristics can identify individuals with masked hypertension.
Hänninen and team studied 1459 individuals with a mean age of 45-74 years who were not receiving any treatment for hypertension, and who participated in the Health 2000 study, a multidisciplinary epidemiologic survey carried out in Finland from 2000 to 2001.
All participants underwent office BP measurement, which consisted of duplicate measurements on one visit, and home BP measurement, which consisted of duplicate measurements over 7 days.
Participants also underwent psychometric testing for hypochondria, using the seven-item Whiteley index rated on a five-point Likert scale (Whiteley-7, range 7-35) where a higher score indicates a high risk for the condition.
The findings revealed that masked hypertension, defined as a normal office BP <140/90 mmHg with elevated home BP ≥135/85 mmHg, was prevalent in 8.1% of the study population.
Multivariate analysis revealed that high-normal systolic and diastolic BP (systolic BP of 130-139 mm Hg and diastolic BP of 85-89 mm Hg), older age, and higher body-mass index (BMI) were independent determinants of masked hypertension (odds ratios [OR]=5.86 and OR=2.99 for SBP and DBP, OR=1.05 per year increase in age, and OR=1.17 per kg/m2 increase in BMI,).
Other determinants were excessive alcohol consumption (more than 24 units a week in men and 16 units in women) and current smoking (OR=2.99 and OR=2.57, respectively).
Diabetes (fasting serum glucose level of at least 7.0 mmol/l and/or history of oral hypoglycemic use or insulin injection) and electrocardiographic-confirmed left-ventricular hypertrophy were also significantly associated with masked hypertension (OR=8.69 and OR=2.51).
In addition, each point increase in hypochondria score on the Whitely-7 index was associated with a 1.08-fold increased chance of masked hypertension.
Physicians should consider home BP management if a patient has a high-normal office BP, diabetes, left-ventricular hypertrophy, and several other conventional cardiovascular risk factors, conclude Marjo-Riitta Hänninen and colleagues.
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By Piriya Mahendra