Several authors found masked hypertension (MH) and masked uncontrolled hypertension (MUCH) to be independent predictors of target organ damages and to be associated with CV events. Variable prevalence of MUCH was reported; importantly it was highest in subjects with high risk (diabetics (DM2), chronic kidney disease (CKD), previous CV events etc.). There is no information on the effect of treatment on CV outcomes in MUCH. Our aim was to analyze clinical characteristics of MUCH and impact of fixed dose combination (FDC) in a group of very high risk patients.
A total of 912 patients (age 73 ± 9.5 years; 46%men) were followed for 6 months in outpatient settings. Of total, 32% had uncomplicated hypertension (HT), 35% were DM2, 52% had coronary heart disease (CHD) and 26% atrial fibrillation (AFib). At baseline, all were on two antihypertensive drugs and additional therapy depending on co-morbidities. Office BP was measured using Omron M6 device following ESH/ESC guidelines, ABPM (MobiloGraph) was performed basal and in MUCH patients third antihypertensive drug was added as a fixed dose combination (FDC). Second ABPM was done 3–6 months later. MUCH was defined as office BP < 140/90 mmHg and 24-h ABP>130/80 mmHg and/or awake ABP >135/85 mmHg and/or sleep ABP >120/70 mmHg. Glomerular filtration rate (GFR) was estimated using CKD-Epi equation, and albuminuria was determined from the 24hurine sample. CKD was defined as eGFR < 60 ml/min1.73m2.
At basal MUCH was found in 22% of patients, and out of them 54.5%, 41%,35.5% and 10% had DM2,CKD,Afib and CHD, respectively. At the end of follow-up, following therapy modification MUCH was found in only 73 patients (8%). All of them were DM2 patients with albuminuria >200 mg/dU and eGFR < 40 ml/min. They were older (68 ± 8 years), obese (BMI 38 ± 2.1 kg/m2) with duration of diabetes >15 years. No gender difference was found.
High prevalence of MUCH in very high risk patients significantly decreased (22%-8%) with FDC therapy. True MUCH were older, obese patients with DM2 and CKD. Aiming to exclude MUCH ABPM should be part of routine work in all high risk patients.
1Clinical Hospital Center Zagreb, University Clinic for CV diseases, Zagreb, Croatia
2Clinical Hospital Center Zagreb, University Clinic for Internal Medicine, Zagreb, Croatia