Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Cardiology

Background:There are limited data on the quality of blood pressure (BP) control during normal daily life, and in particular, the prevalence of {u2018}masked uncontrolled hypertension{u2019} (MUCH) in people with treated and seemingly well-controlled BP is unknown. Objectives: To define the prevalence and characteristics of MUCH among hypertensive patients with controlled office blood pressure readings. Methods:Weenrolled 150hypertensive patients presented to the specialized hypertension clinic at Kasr Al-Ainy Hospital, Cairo University. All patients were on antihypertensive treatment and their office blood pressure readings were well controlled (less than 140/90 mmHg for at least two visits, one month apart) but in diabetic patients, target BP was less than 140/85mmHg).Automated office BP measurement was done, according to the standard protocols, using an authorized automated device. Cardiovascular disease risk factors were documented by history, clinical examination, and laboratory data. All patients underwent ambulatory blood pressure monitoring (ABPM) for 24 hours, within a week after the office visit. Results:Masked uncontrolled hypertension was diagnosed in the study patients if despite controlled clinic BP, the mean 24-h ABPM average remained elevated (24-h systolic BP {u2265}130 mmHg and/or 24-h diastolic BP {u2265}80 mmHg). Fifty one patients (34%) had MUCH according to 24-h ABPM criteria (mean age 54.8 ± 8.3 years, 60.8% men). The prevalence of MUCH was significantly higher in patients at high cardiovascular risk (smokers, diabetes, obesity). Masked uncontrolled hypertension was most often because of poor control of nocturnal BP, with the proportion of patients in whom MUCH was solely attributable to an elevated nocturnal BP almost double that solely attributable to daytime BP elevation (53% vs. 28%, P< 0.001). Conclusion: The prevalence of masked suboptimal BP control in patients with treated and well-controlled clinic BP is high. Clinic BP monitoring alone is thus inadequate to optimize BP control because many patients have an elevated nocturnal BP. These findings suggest that ABPM should become more routineto confirm BP control, especially in patients with higher cardiovascular risk profile

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