Identifying masked uncontrolled hypertension in the community pharmacy setting.

Masked uncontrolled hypertension (MUCH) is associated with an increased cardiovascular risk. This condition is frequent in the community pharmacy (i.e., CP-MUCH), but there is no evidence on the factors associated with its presence in that setting. The aim of this analysis was to explore these factors. A sample of 98 treated hypertensive patients from the MEPAFAR study, with normal community pharmacy blood pressure (CPBP <135/85 mmHg), were analyzed. Blood pressure (BP) was also measured at home (4 days) and monitored for 24 h. CP-MUCH was identified when either ambulatory (daytime) or home BP averages were equal to or higher than 135/85 mmHg. A multivariate logistic regression analysis was carried out to identify the factors associated with CP-MUCH. The prevalence of CP-MUCH tends to be higher as systolic and diastolic CPBP increase, reaching 47% in patients with both systolic  and diastolic CPBP equal to or higher than 123 mmHg and 79 mmHg, respectively.  The multivariate regression analysis showed only systolic CPBP as an independent factor of CP-MUCH [≥123 mmHg: odds ratio=16.46 (P=0.012); from 115 to 122.9 mmHg: odds ratio=10.74 (P=0.036); systolic CPBP <115 mmHg as the reference]. Further assessment, using ambulatory and/or home BP monitoring, is recommended in patients with normal CPBP, but systolic CPBP equal to or higher than 115 mmHg. A more feasible approach would be evaluating patients with systolic CPBP equal to or higher than 123 mmHg and diastolic CPBP equal to or higher than 79 mmHg.