Masked phenomenon: renal and cardiovascular complications; review and updates

Figures & data

Figure 1. Blood pressure phenotypes. BP: Blood pressure; MHTN: masked hypertension; MUHT: masked uncontrolled hypertension; HBP: home blood pressure; ABPM: ambulatory blood pressure monitoring.

Table 1. Masked hypertension prevalence in general population and chronic kidney disease patients.

Prevalence of masked hypertension
General population		Chronic kidney disease
Percentage	References	Percentage	References
8–20%	[8, 20]	28%	[11]
19%	[9]	25% (BP during day)	[12]
13%	[16]	43% (BP during day and night)	[12]
10%	[17,18]	8%	[13]
21.9%	[19]
12.3%	[21]

Table 2. Summary of comparison between masked/masked uncontrol hypertension outcomes.

MHTN and MUHTN have a higher risk of all-cause death and CV events.	[3]
MHTN increases death risk in CKD	[124]
MHTN increases MI, stroke, congestive HF, peripheral vascular disease.	[56, 84]
MHTN increases the risk of deadly and non-deadly MI.	[56]
MHTN increases ESRD risk and death.	[56,84]
MHTN can progress to SHTN.	[121,122]
MUHTN increases SHTN development risk.	[117]
MUHTN increases CV complications risk and all-cause mortality.	[118]

Masked hypertension (MHTN), Masked uncontrolled hypertension.

Asayama K, Thijs L, Li Y, et al. Setting thresholds to varying blood pressure monitoring intervals differentially affects risk estimates associated with white-coat and masked hypertension in the population. Hypertension. 2014;64(5):935–942. doi: 10.1161/HYPERTENSIONAHA.114.03614.

 PubMed Web of Science ®Google Scholar

Andalib A, Akhtari S, Rigal R, et al. Determinants of masked hypertension in hypertensive patients treated in a primary care setting. Intern Med J. 2012;42(3):260–266. doi: 10.1111/j.1445-5994.2010.02407.x.

 PubMed Web of Science ®Google Scholar

Drawz PE, Alper AB, Anderson AH, et al. Masked hypertension and elevated nighttime blood pressure in CKD: prevalence and association with target organ damage. Clin J Am Soc Nephrol. 2016;11(4):642–652. doi: 10.2215/CJN.08530815.

 PubMed Web of Science ®Google Scholar

Verberk WJ, Kessels AG, de Leeuw PW. Prevalence, causes, and consequences of masked hypertension: a meta-analysis. Am J Hypertens. 2008;21(9):969–975. doi: 10.1038/ajh.2008.221.

 PubMed Web of Science ®Google Scholar

Pogue V, Rahman M, Lipkowitz M, et al. Disparate estimates of hypertension control from ambulatory and clinic blood pressure measurements in hypertensive kidney disease. Hypertension. 2009;53(1):20–27. doi: 10.1161/HYPERTENSIONAHA.108.

 PubMed Web of Science ®Google Scholar

Mancia G, Kreutz R, Brunström M,G, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41(12):1874–2071. doi: 10.1097/HJH.0000000000003480.

 PubMed Web of Science ®Google Scholar

Omboni S, Aristizabal D, De la Sierra A, et al. Hypertension types defined by clinic and ambulatory blood pressure in 14 143 patients referred to hypertension clinics worldwide. Data from the ARTEMIS study. J Hypertens. 2016;34(11):2187–2198. doi: 10.1097/HJH.0000000000001074.

 PubMed Web of Science ®Google Scholar

Stergiou GS, Bliziotis IA. Home blood pressure monitoring in the diagnosis and treatment of hypertension: a systematic review. Am J Hypertens. 2011;24(2):123–134. doi: 10.1038/ajh.2010.194.

 PubMed Web of Science ®Google Scholar

Bangash F, Agarwal R. Masked hypertension and white-coat hypertension in chronic kidney disease: a meta-analysis. Clin J Am Soc Nephrol. 2009;4(3):656–664. doi: 10.2215/CJN.05391008.

 PubMed Web of Science ®Google Scholar

Fukuhara M, Arima H, Ninomiya T, et al. White-coat and masked hypertension are associated with carotid atherosclerosis in a general population: the Hisayama study. Stroke. 2013;44(6):1512–1517. doi: 10.1161/STROKEAHA.111.000704.

 PubMed Web of Science ®Google Scholar

Wang YC, Shimbo D, Muntner P, et al. Prevalence of masked hypertension among US adults with nonelevated clinic blood pressure. Am J Epidemiol. 2017;185(3):194–202. doi: 10.1093/aje/kww237.

 PubMed Web of Science ®Google Scholar

Banegas JR, Ruilope LM, de la Sierra A, et al. Relationship between clinic and ambulatory blood-pressure measurements and mortality. N Engl J Med. 2020;382(8):786–786. doi: 10.1056/NEJMc2001445.

 PubMed Web of Science ®Google Scholar

de la Sierra A, Gorostidi M, Banegas JR, et al. Nocturnal hypertension or nondipping: which is better associated with the cardiovascular risk profile? Am J Hypertens. 2014;27(5):680–687. doi: 10.1093/ajh/hpt175.

 PubMed Web of Science ®Google Scholar

Minutolo R, Gabbai FB, Agarwal R, et al. Assessment of achieved clinic and ambulatory blood pressure ­recordings and outcomes during treatment in hypertensive patients with CKD: a multicenter prospective cohort study. Am J Kidney Dis. 2014;64(5):744–752. doi: 10.1053/j.ajkd.2014.06.014.

 PubMed Web of Science ®Google Scholar

Wang C, Zhang J, Li Y, et al. Masked hypertension, rather than white-coat hypertension, has a prognostic role in patients with nondialysis chronic kidney disease. Int J Cardiol. 2017;230:33–39. doi: 10.1016/j.ijcard.2016.12.105.

 PubMed Web of Science ®Google Scholar

Cohen LP, Schwartz JE, Pugliese DN, et al. Short-term reproducibility of masked hypertension among adults without office hypertension. Hypertension. 2020;76(4):1169–1175. doi: 10.1161/HYPERTENSIONAHA.120.15287.

 PubMed Web of Science ®Google Scholar

Pickering TG, Gerin W, Schwartz JE, et al. Should doctors still measure blood pressure? The missing patients with masked hypertension. J Hypertens. 2008;26(12):2259–2267. doi: 10.1097/HJH.0b013e32831313c4.

 PubMed Web of Science ®Google Scholar

Kim HJ, Shin JH, Lee Y, et al. Clinical features and predictors of masked uncontrolled hypertension from the Korean Ambulatory Blood Pressure Monitoring Registry. Korean J Intern Med. 2021;36(5):1102–1114. doi: 10.3904/kjim.2020.

 PubMed Web of Science ®Google Scholar

Ben-Dov IZ, Ben-Arie L, Mekler J, et al. Reproducibility of white-coat and masked hypertension in ambulatory BP monitoring. Int J Cardiol. 2007;117(3):355–359. doi: 10.1016/j.ijcard.2006.04.088.

 PubMed Web of Science ®Google Scholar