ReviewFranz Volhard lecture: should doctors still measure blood pressure? The missing patients with masked hypertensionPickering, Thomas G; Gerin, William; Schwartz, Joseph E; Spruill, Tanya M; Davidson, Karina WAuthor Information College of Physicians and Surgeons, Columbia University Medical Center, New York, USA Received 11 July, 2008 Revised 29 July, 2008 Accepted 31 July, 2008 Correspondence to Thomas G. Pickering, MD, DPhil, Columbia University Medical Center, 622 West 168th Street, PH9-941, New York, NY 10032, USA Tel: +1 212 342 4485; fax: +1 212 305 3172; e-mail: [email protected] Journal of Hypertension: December 2008 - Volume 26 - Issue 12 - p 2259-2267 doi: 10.1097/HJH.0b013e32831313c4 Buy Metrics Abstract The traditional reliance on blood pressure (BP) measurement in the medical setting misses a significant number of individuals with masked hypertension, who have normal clinic BP but persistently high daytime BP when measured out of the office. We suggest that masked hypertension may be a precursor of clinically recognized sustained hypertension and is associated with increased cardiovascular risk compared with consistent normotension. We discuss factors that may contribute to clinic–daytime BP differences as well as the changing relationship between these two measures over time. Anxiety at the time of BP measurement and having been diagnosed as hypertensive appear to be two possible mechanisms. The identification of individuals with masked hypertension is of great clinical importance and requires out-of-office BP screening. Ambulatory BP monitoring is the best established technique for doing this, but home monitoring may be applicable in the future. © 2008 Lippincott Williams & Wilkins, Inc.