Background:
39-year-old woman is evaluated for possible high blood pressure (BP). Her home blood pressure using an upper arm, Omron blood-pressure cuff is in the 150-range systolic at home. However, in the clinic, her blood pressure is 129/79. The Omron cuff correlates with the office measurement.
The patient is sent to nephrology for further evaluation. 24-hour ambulatory blood pressure monitoring (ABPM) is performed. The patient’s blood pressure is read every 1/2 hour while awake and every hour whilst asleep. 24-hour results show an average blood pressure while awake of 154/91 and 132/81 while asleep.
Please answer the following questions:
What does this patient have?
Masked hypertension
Describe masked hypertension.
Masked hypertension is defined as blood pressure that is normal in the office but elevated in the ambulatory setting, outside of the office.
Masked hypertension is a phenomenon where blood pressure readings taken in a clinical setting appear normal, but are elevated when measured outside of that environment, such as during daily activities. This condition can be missed during routine office visits, highlighting the importance of ambulatory blood pressure monitoring (ABPM) for accurate diagnosis.
What is the most appropriate management for masked hypertension in this case?
Start antihypertensive therapy.
Masked hypertension can increase cardiovascular risk. Starting antihypertensive therapy like lisinopril or losartan can help manage this condition effectively, reducing the risk of complications associated with untreated hypertension.
How is masked hypertension associated with cardiovascular risk compared to normotensive individuals? That is to say, how many times higher is the risk for cardiovascular disease and all-cause mortality compared to normotensive patients?
Masked hypertension is associated with a cardiovascular disease and all-cause mortality risk twice as high.
This underscores the importance of monitoring blood pressure outside of medical visits.
Do guidelines recommend starting antihypertensive medications for masked hypertension?
Yes, if daytime ambulatory BP monitoring or home BP measurements are ≥130/80 mm Hg after a 3-month trial of lifestyle modifications.
In this setting normal blood pressure in the clinic or office is less than 140/90 mmHg.
Why is repeating ambulatory blood pressure monitoring (ABPM) deemed unnecessary for this patient?
The diagnosis is made. At this time, given the above information, self-reported blood pressure measurements using the Omron cuff are considered sufficient to follow progress in this patient over time.
Discussion:
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