Abstract 1304: Determinants of Masked Hypertension in Hypertensive Patients Treated in the Real-Life Observational DioVantageIV Study
Background: Masked hypertension (MH) is not a rare phenomenon, with a reported prevalence between 3% to 49% in the general population. The SHEAF study demonstrated that the CV risk in subjects with MH is identical to that of subjects with uncontrolled hypertension.
Objectives: To identify determinants of MH in patients treated with a valsartan-based therapy in Canadian primary care settings.
Methods: Office blood pressure (OBP) was measured at baseline and after three months of valsartan-based therapy. A cross-sectional analysis was performed on patients who recorded their home BP readings for 7 consecutive days at month 3 using an Omron HEM-711 apparatus. MH was defined as OBP≤140/90 mm Hg and home BP >135/85 mm Hg. Diabetic patients were excluded from this analysis. A logistic regression model was used to identify independent determinants of MH among patients with controlled OBP. Odds ratio (OR) and confidence intervals (CI) were used to investigate the association between each exploratory variable and the hypertension status.
Results: Of the 40,035 treated patients, 4,611 non-diabetic patients self-reported their home BP readings. MH was observed in 1,233 (37.9%) of patients with controlled OBP (3,247 patients). The OR of having MH for men (versus women) was 1.94 (p<0.001). MH was associated with increases in age, body-mass index and multi-antihypertensive therapies (p<0.05). Concomitant use of beta-blocker (OR 0.39, p=0.005) or ACE inhibitor (OR 0.43, p=0.02) with valsartan and office systolic BP 135 mm Hg or below were associated with a reduced risk of MH (p<0.01). Congestive heart failure, dyslipidemia, post-myocardial infarction status, left ventricular hypertrophy, years of anti-hypertensive therapy, and concomitant use of hydrochlorothiazide or calcium-channel blocker with valsartan were not significant predictors of MH.
Conclusion: The prevalence of MH in hypertensive patients with controlled OBP was 37.9%. In this analysis, MH was associated with CV risk factors such as male gender, aging, obesity, and multi-antihypertensive therapies. These results support the use of home blood pressure measurements in hypertensive patients with controlled OBP.