Masked Hypertension in Diabetes Mellitus: Treatment Implications for Clinical Practice
Open accessAbstract
Although distinguishing features of masked hypertension in diabetics are well known, the significance of antihypertensive treatment on clinical practice decisions has not been fully explored. We analyzed 9691 subjects from the population-based 11-country International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes. Prevalence of masked hypertension in untreated normotensive participants was higher ( P <0.0001) among 229 diabetics (29.3%, n=67) than among 5486 nondiabetics (18.8%, n=1031). Over a median of 11.0 years of follow-up, the adjusted risk for a composite cardiovascular end point in untreated diabetic-masked hypertensives tended to be higher than in normotensives (hazard rate [HR], 1.96; 95% confidence interval [CI], 0.97–3.97; P =0.059), similar to untreated stage 1 hypertensives (HR, 1.07; CI, 0.58–1.98; P =0.82), but less than stage 2 hypertensives (HR, 0.53; CI, 0.29–0.99; P =0.048). In contrast, cardiovascular risk was not significantly different in antihypertensive-treated diabetic-masked hypertensives, as compared with the normotensive comparator group (HR, 1.13; CI, 0.54–2.35; P =0.75), stage 1 hypertensives (HR, 0.91; CI, 0.49–1.69; P =0.76), and stage 2 hypertensives (HR, 0.65; CI, 0.35–1.20; P =0.17). In the untreated diabetic-masked hypertensive population, mean conventional systolic/diastolic blood pressure was 129.2±8.0/76.0±7.3 mm Hg, and mean daytime systolic/diastolic blood pressure 141.5±9.1/83.7±6.5 mm Hg. In conclusion, masked hypertension occurred in 29% of untreated diabetics, had comparable cardiovascular risk as stage 1 hypertension, and would require considerable reduction in conventional blood pressure to reach daytime ambulatory treatment goal. Importantly, many hypertensive diabetics when receiving antihypertensive therapy can present with normalized conventional and elevated ambulatory blood pressure that mimics masked hypertension.
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Masked hypertension may occur in up to 20% of the general population, with greater prevalence in those with established disease such as type 2 diabetes (>30%).
“and may occur in up to 20% of the general population [4], with greater prevalence in those with established disease, such as type 2 diabetes (>30%) [31].”
From The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance (2022) · cites this paper as [31]
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- Authors
- Franklin, S. S., Thijs, L., Li, Y., Hansen, T. W., Boggia, J., Liu, Y., Asayama, K., Björklund-Bodegård, K., Ohkubo, T., Jeppesen, J., Torp-Pedersen, C., Dolan, E., Kuznetsova, T., Stolarz-Skrzypek, K., Tikhonoff, V., Malyutina, S., Casiglia, E., Nikitin, Y., Lind, L., Sandoya, E., Kawecka-Jaszcz, K., Filipovský, J., Imai, Y., Wang, J., Ibsen, H., O’Brien, E., & Staessen, J. A.
- Affiliations
- University of California, Irvine (US)
- From the Heart Disease Prevention Program, Division of Cardiology, School of Medicine, University of California, Irvine, California (S.S.F.); The Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., Y.L., K.A., T.K., J.A.S.); Department of Internal Medicine, Division of Hypertension, University Medical Centre Ljubljana, Slovenia (J.B.H.); Center for Epidemiological Studies and Clinical...
- ORCID
- Venue
- Hypertension
- Published
- 2013-05
- Volume
- 61
- Issue
- 5
- Pages
- 964-971
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- PMC
- PMC3631136
- OpenAlex
- W2148484476
- Cited by
- 167
- References
- 62
- Citations by year
- 2026: 4 · 2025: 10 · 2024: 9 · 2023: 9 · 2022: 16 · 2021: 8 · 2020: 19 · 2019: 13 · 2018: 17 · 2017: 9 · 2016: 18 · 2015: 10 · 2014: 17 · 2013: 8
- FWCI
- 11.88
- Type
- journal article
- Language
- en
- Open access
- Licence
- other-oa
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
- Research Publications (Maastricht University) (acceptedVersion, other-oa)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Homo Politicus (Academy of Humanities and Economics in Lodz) (submittedVersion)
- Jagiellonian University Repository (Jagiellonian University) (submittedVersion, cc-by-nc-nd)
- Homo Politicus (Academy of Humanities and Economics in Lodz) (submittedVersion, cc-by-nc-nd)
- Lirias (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Funders
- Hjerteforeningen (01-2-9-9A-22914)
- European Commission (LSHM-CT-2006-037093, 201550, IC15-CT98-0329-EPOGH, 278249)
- Ministry of Education, Culture, Sports, Science and Technology (23390171, 23790242, 23249036)
- National Natural Science Foundation of China (30871360, 30871081)
- Ministry of Health, Labour and Welfare
- Universidad de la República Uruguay (IC15-CT98-0329-EPOGH)
- Vlaamse regering
- H. Lundbeck A/S
- Japan Society for the Promotion of Science (25253059)
- Comisión Sectorial de Investigación Científica
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- masked hypertension, diabetes mellitus, antihypertensive therapy, cardiovascular risk, ambulatory blood pressure, untreated hypertension, stage 1 hypertension, stage 2 hypertension, prevalence, cardiovascular outcomes, blood pressure reduction, ambulatory blood pressure monitoring, cardiovascular risk reduction
- MeSH terms
- Adult, Aged, Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, Cardiovascular Diseases, Diabetes Mellitus, Female, Follow-Up Studies, Humans, International Cooperation, Male, Middle Aged, Practice Patterns, Physicians', Retrospective Studies, Risk Factors, Cohort Studies, Comorbidity, Prevalence, Treatment Outcome, Masked Hypertension
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Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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