Masked Hypertension: How to Identify and When to Treat?

Approximately one out of 7-8 individuals with normal blood pressure (BP) in the clinic or doctor's office and one third of patients with chronic kidney disease with normal clinic BP have elevated ambulatory BP (masked hypertension). Patients with masked hypertension have an increased risk for target organ damage and a two-fold increased risk for cardiovascular events compared to patients with normal clinic and ambulatory BP. Despite this elevated risk for adverse outcomes, patients with masked hypertension have been excluded from hypertension trials because of their normal clinic BP. It is still unknown whether the reduction in target organ damage and adverse cardiovascular outcomes associated with treatment of hypertension extends to patients with masked hypertension. Ongoing and planned interventional studies will provide an answer to this crucial question in a few years. At present, it seems reasonable to follow the suggestion of current European guidelines, that lifestyle measures and drug treatment should be considered in the presence of masked hypertension.