Masked Uncontrolled Hypertension in the Elderly: A Dangerous Affair

Blood pressure (BP) values and thresholds are dependent on the setting in which BP is measured. When patients are categorized according to office and ambulatory or home BP, different combinations may result, with different prognostic significance. There is little doubt that patients with uncontrolled hypertension in the office and out-of-office have a worse prognosis than patients with controlled hypertension. Studies mainly performed in the general population, involving untreated or treated subjects, indicate that the incidence of cardiovascular events is not significantly different between individuals with white-coat hypertension and true normotension, whereas the outcome is worse in those with masked hypertension.^1–3 Thus, each BP elevation carries an increase in risk which adds to that of other BP elevations, in a sort of "continuum" from normotension to sustained hypertension, passing through white-coat hypertension and masked hypertension. Such risk may vary in treated vs. untreated patients and in younger vs. older hypertensives.^4,5 It is thus important to identify patients with masked hypertension or white-coat hypertension because failure to do so may result in significant misdiagnosis and mismanagement of hypertension, with increase in patients' cardiovascular risk.

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