Clinical features and predictors of masked uncontrolled hypertension from the Korean Ambulatory Blood Pressure Monitoring Registry

• Main Authors: Hyun-Jin Kim, Jeong-Hun Shin, Yonggu Lee, Ju Han Kim, Sun Ho Hwang, Woo Shik Kim, Sungha Park, Sang Jae Rhee, Eun Mi Lee, Sang Hyun Ihm, Wook Bum Pyun, Jinho Shin
• Format: Article
• Language: English
• Published: The Korean Association of Internal Medicine 2021-09-01
• Series: The Korean Journal of Internal Medicine
• Subjects: masked uncontrolled hypertension; blood pressure monitoring, ambulatory; blood pressure
• Online Access: http://www.kjim.org/upload/pdf/kjim-2020-650.pdf
• ISSN: 1226-3303; 2005-6648

Background/Aims The clinical characteristics of patients with masked uncontrolled hypertension (MUCH) have been poorly defined, and few studies have investigated the clinical predictors of MUCH. We investigated the demographic, clinical, and blood pressure (BP) characteristics of patients with MUCH and proposed a prediction model for MUCH in patients with hypertension. Methods We analyzed 1,986 subjects who were enrolled in the Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) Registry and taking antihypertensive drugs, and classified them into the controlled hypertension (n = 465) and MUCH (n = 389) groups. MUCH was defined as the presence of a 24-hour ambulatory mean systolic BP ≥ 130 mmHg and/or diastolic BP ≥ 80 mmHg in patients treated with antihypertensive drugs, having normal office BP. Results Patients in the MUCH group had significantly worse metabolic profiles and higher office BP, and took significantly fewer antihypertensive drugs compared to those in the controlled hypertension group. Multivariate logistic regression analyses identified high office systolic BP and diastolic BP, prior stroke, dyslipidemia, left ventricular hypertrophy (LVH, ≥ 116 g/m2 for men, and ≥ 96 g/m2 for women), high heart rate (≥ 75 beats/min), and single antihypertensive drug use as independent predictors of MUCH. A prediction model using these predictors showed a high diagnostic accuracy (C-index of 0.839) and goodness-of-fit for the presence of MUCH. Conclusions MUCH is associated with a high-normal increase in office BP and underuse of antihypertensive drugs, as well as dyslipidemia, prior stroke, and LVH, which could underscore achieving optimal BP control. The proposed model accurately predicts MUCH in patients with controlled office BP.