Do we really know how common hypertension is?

Abstract

For over a century the use of brachial blood pressures in determining cardiovascular risk has been a cornerstone of medical practices globally. Clear evidence confirms that increased blood pressure results in stroke, heart disease, kidney disease and death, and by lowering blood pressure effectively, significantly less cardiovascular events occur. But based on 24-hour blood pressure measurements we now know that a clinic or office blood pressure measurement does not necessarily reflect the true blood pressure of a patient – out-of-office readings are often completely different from those in the clinic. Approximately 15–30% of individuals present with white-coat hypertension, i.e. very high blood pressure in the medical environment, and normal out-of-office blood pressure. Even more disconcerting is masked hypertension, where patients present with normal pressures in the clinic, but are hypertensive out of the medical environment. It occurs in 18–45% of patients (depending on factors such as age and disease conditions), and carries similar cardiovascular risk than true hypertension. These realities clearly advise that burden of disease estimates for hypertension are likely to be inaccurate, and potentially significantly underestimate true hypertension. Furthermore, healthcare practitioners should be aware of the limitations of conventional clinic blood pressures, and take note of the usefulness of additional blood pressure monitoring options