Masked Asleep Hypertension Prevalent Among Adult US Patients

By Dave Quaile, /alert Contributor
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Rates of high blood pressure while sleeping without high BP measured in clinics, also known as masked hypertension, are high among US adults, according to a study recently published in JAMA Cardiology.

While asleep BP is linked to an increased CVD risk, data regarding masked asleep hypertension is lacking. 

“Asleep hypertension, defined as high BP while sleeping, with or without high clinic BP, is associated with an increased risk of cardiovascular disease,” Yiyi Zhang, PhD, from the Division of General Medicine at Columbia University, and colleagues wrote in the study. “However, most large US population-based cohorts and US national health surveys have not performed ABPM, and a national estimate for asleep hypertension is currently lacking.”

To evaluate the prevalence of masked asleep hypertension in a US population, the researchers conducted a cohort analysis that included 3,000 participants with a mean age of 52 years from 4 US population-based studies that conducted 24-hour ambulatory BP monitoring and 17,969 participants with a mean age of 47 years, in the 2011-2016 National Health and Nutrition Examination Survey without ABPM. The majority of participants in both groups were female. 

The researchers imputed masked asleep hypertension status in NHANES using a 2-stage multiple imputation process.

The data showed an estimated prevalence of masked asleep hypertension among US adults of 18.8% (95% CI, 16.7%-20.8%; 44.4 million US adults) using the JNC7 guideline and 22.7% (95% CI, 20.6%-24.8%; 53.7 million US adults) using the 2017 ACC-AHA guideline criteria. 

The researchers also found that the prevalence of masked asleep hypertension was higher among older adults (aged 65 years, 24.4% [95% CI, 20.7%-28.0%]), men (27.0% [95% CI, 24.1%-29.9%]), non-Hispanic Black participants (28.7% [95% CI, 25.4%-32.0%]), those who were taking antihypertensives (24.4% [95% CI, 21.1%-27.8%]), those who had masked daytime hypertension (44.7% [95% CI, 40.1%-49.3%]), patients with diabetes (27.6% [95% CI, 23.5%-31.8%]), obesity (24.3% [95% CI, 21.8%-26.9%]), or CKD  (21.5% [95% CI, 17.3%-25.6%]) using the 2017 ACC-AHA guideline. 

An estimated 28.2 million US adults had isolated masked asleep hypertension, using JNC7 guideline criteria, as did an estimated 13.3% (31.5 million) using 2017 ACC-AHA guideline criteria.

These results underscore the potential importance of using ABPM not only to confirm a diagnosis of hypertension but to identify other high-risk BP phenotypes,” Zhang and colleagues wrote. “Future research should investigate the possible cardiovascular risk reduction and economic benefits of treating asleep hypertension.”

Disclosure: Zhang reports no relevant financial disclosures. Please see the study for a complete list of author disclosures. 


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