Nadciśnienie tętnicze maskowane — niedoceniany problem

Masked hypertension should be defined in untreated patients, who have normal office blood pressure < 140/ /90 mm Hg, with elevated out-of-office average levels in home blood pressure measurement (HBPM) or/and ambulatory blood pressure monitoring (ABPM) with a daytime BP ³ 135/85 mm Hg or nighttime BP ³ 120/70 mm Hg. Performing out-of-office blood pressure measurements is a sine qua non condition for MH diagnosis. Masked hypertension can be found in even 30% of patients with a normal office blood pressure. To detect this type of hypertension, patients with high-normal BP, should be regularly controlled. The prevalence is greater in middle age men, with high-normal BP, smokers, abusing alcohol or other drugs and with higher levels of stress. Obesity, diabetes, chronic kidney disease, obstructive sleep apnea are also associated with an increased prevalence of masked hypertension. A special form of masked hypertension, associated with increased risk of hypertensive target organ damage (HMOD), is nocturnal hypertension and non-dipping. The risk of cardiovascular events is substantially greater in masked hypertension, compared with normotension. Because of frequent occurrence HMOD and comorbidities in population with MH, they are usually high-risk patients. It was estimated, that over 35% in individuals with masked hypertension, will develop persistence hypertension. But one in five patients, in long-term observation, will have only out- -of-office elevated blood pressure, which potentially delays diagnosis and treatment, with the progressive development of HMOD. Therefore, in masked hypertension lifestyle changes and antihypertensive drug treatment are recommended. According to European Society of Hypertension/European Society of Cardiology guidelines, ABPM or HBPM is specifically recommended for clinical indications, such as identifying and control of antihypertensive treatment effect in masked hypertension.