What is masked hypertension? Normal blood pressure at the doctor, but...

You ask: What is masked hypertension?

It has been found that it is possible for high blood pressure to occur in people in the home environment and during everyday life, even after repeated measurement of normal blood pressure values by a doctor.

Hypertension (high blood pressure) is a disease that can be asymptomatic for many years.

What is it?

A person has high blood pressure but does not know it. He or she does not experience any discomfort, feels fine.

The blood vessels and the cardiovascular system in general are sufficiently elastic and tolerate the increase in load well. They are able to adapt to the body's needs.

High blood pressure gradually adversely affects the whole organism.
When the compensatory mechanisms are no longer sufficient or the blood pressure has risen too much, a problem arises.

An example of this is also a violent and excessive hypertensive crisis, which can endanger a person's health and life.

Hypertension is also referred to as the silent killer.

Are you wondering why?

The reason is its complications that come from full health. That is: in a previously healthy person who has had no health problems, a sudden, sharp reversal occurs.

Examples include a heart attack, a malignant arrhythmia or a stroke. These serious complications can end in the death of the person affected.

Hypertension = persistently elevated blood pressure above 140/90 mmHg.

High blood pressure is not just about seeing a reading higher than 140/90 on a blood pressure monitor.
The problem has a broader basis.

Such an increase in blood pressure causes progressive damage throughout the human body.
The cardiovascular system itself, the brain, the kidneys, the eyes, and the body's tissues and organs in general suffer.

What causes high blood pressure?

There are two possibilities.

The first form has no known cause. It's referred to as primary or essential hypertension.

The second group includes hypertension that is caused by another disease (secondary hypertension). It arises, for example, in kidney disease or as a result of a disorder of the endocrine system and therefore as a consequence of a hormonal imbalance.

In general, the risk factors leading to high blood pressure are:

• older age
• gender (the incidence increases in post-menopausal women)
• genetic predisposition and family history
• disorders of vasomotor regulation - regulation of muscle tension in blood vessels
• smoking
• alcoholism
• overweight and obesity
• excessive salt intake in the diet - sodium (Na)
• insufficient dietary intake of magnesium (Mg), potassium (K) and calcium (Ca)
• sedentary lifestyle and lack of exercise
• poor lifestyle
• the negative impact of environmental pollution

Let's quickly review the symptoms that can occur with high blood pressure:

• Fatigue
• general weakness
• headache, unpleasant sensation in the head, pressure, tension
• dizziness - light-headedness
• feeling of imbalance, pulling to the side
• tinnitus, also as whistling or murmuring
• visual disturbance - blurred or double vision
• redness of the skin and face, paleness of the skin
• feeling hot and hot flashes, but also feeling cold
• excessive sweating
• heaviness in the stomach to feeling sick and vomiting
• trembling of the limbs and body
• sleep disturbances
• disturbances in concentration
• general restlessness
• nosebleeds (epistaxis)
• chest pain - pressure, tightness, burning, other unpleasant sensations
• heart palpitations - palpitations
• difficulty breathing (dyspnoea)
• swelling of limbs, body

For more information about high blood pressure, see the article Hypertension

The rise and fall of pressure during the day or night

Blood pressure is not a constant variable. It rises and falls during the day. Its value depends on physical stress or mental state.

It is normal for blood pressure to fall at night, during sleep. On the contrary, it rises in the morning even during physical or mental stress.

The value of blood pressure is influenced by various internal and external factors. Examples of internal factors are hormonal regulation, metabolic rate, wakefulness and sleep. And the external ones mentioned are activity.

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The concept of circadian rhythm is also well known.

It is a biological rhythm (biorhythm), namely the fluctuations and rises in the activity of the organism during a period of time. Different processes change during a 24-hour period.

Even the biorhythm is influenced by the day of the week (Monday) and also by the season.

Two terms are used:

1. diurnal - daily, tied to the time of day, a cycle during the day or within 24 hours.
2. nocturnal - nocturnal, associated with night

Want to know what masked hypertension is?
What are its risks?
Why is it dangerous?
Read on.

Masked hypertension = high blood pressure hidden from the doctor

It happens that a person has his blood pressure repeatedly measured at home. He goes to the doctor and there the blood pressure readings are fine.

White coat effect, white coat phenomenon or white coat syndrome.

You may have heard of white coat syndrome.

Fear, anxiety, nervousness, apprehension and uncertainty, tremors, excessive sweating, sweaty hands, dry mouth, increased pulse and heart palpitations = increased blood pressure.

Are you afraid of doctors, hospital environments and blood pressure readings?
This stress is the basis of the increase in pressure. It leads to hypertension being measured.

However, blood pressure during a normal day is not elevated, it is normal.

Medication for hypertension lowers blood pressure.

In case you have good pressure, the medication will work by lowering it. The result will be blood pressure that is too low.

You feel excessive fatigue, weakness, dizziness, a feeling of fainting, blackness before your eyes, leading to fainting to collapse - short-term loss of consciousness.

The opposite is masked hypertension.

In a doctor's office or hospital, normal blood pressure will be measured.

However, during normal life and at home, high blood pressure readings are repeatedly measured.

Hypertension is not treated, which over time leads to complications and ultimate health or life threatening.

It may also be referred to as:
White coat hypertension
Reverse or reversed white coat hypertension
Undetected white coat hypertension
White coat normotension
Isolated clinical hypertension
Isolated ambulatory hypertension

The following terms are also used in connection with blood pressure measurement:
Office blood pressure (OBP) - blood pressure measurement in a hospital setting.
Home blood pressure (HBP) - blood pressure measured at home.

Based on various studies, it has been found that masked hypertension is a relatively common problem. It occurs in about one-fifth to one-third of the population.

And that's without gender differences.

Young adults are affected, but also children and adolescents.

It is reported that this form of hypertension can be present in up to 10 percent of adolescents and children.

Obesity in children and young people is mainly mentioned in connection with it.

Are you interested in the causes of masked hypertension?

The cause has not been clarified.

However, some negative influences are considered, such as:

• Smoking
• high blood pressure variability and time of day - diurnal rhythm
• alcohol
• reduced physical activity
• increased intake of caffeine or energy drinks
• use of hormonal contraceptives
• increased reactivity to daily stressors
• the effect of prolonged standing

The risks are clear.

Like normal hypertension, masked hypertension is characterized by negative effects. Late complications are a risk.

This is due to inadequate or no treatment.

Three main groups of complications are mentioned:

1. the development of permanent hypertension, also in children
2. increased frequency of organ damage,
   • mainly the heart and blood vessels, but also the brain, kidneys and retina
   • the negative impact on children in later adulthood is also highlighted
3. increased risk of cardiovascular disease
   • and death due to cardiovascular complications

Recognize the serious complications of hypertension:

• Atherosclerosis
• ischaemic heart disease
• heart failure
• heart muscle infarction
• arrhythmias
• cor pulmonale
• stroke

Interesting:
About 10% of adults have white coat syndrome.
About 10% of adults have masked hypertension.
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10% of adults are treated unnecessarily for white coat syndrome.
And about 10% are untreated or undertreated for the masked form.

Diagnosis = problem

The problem is not that we don't have diagnostic methods available.

But...

In a situation where a doctor repeatedly measures normal blood pressure, there's no reason to send the person for another specialist test. He's not looking for masked hypertension.

And a person with high blood pressure is untreated or under-treated. His blood pressure is much higher on a normal day than what the doctor measures.

But it is necessary to think about masked hypertension...

Look for this form of high blood pressure especially in cases such as:

• randomly and repeatedly measured high blood pressure at home, during normal life
• in men
• in smokers
• people with diabetes
• obesity
• people with borderline blood pressure values - higher normal blood pressure

Masked hypertension and the childhood period

It is also reported that masked hypertension in childhood is accompanied by an increase in heart rate, with higher blood pressure values at night. It should also be kept in mind in the case of enlargement of the left ventricle of the heart (hypertrophy).

How is the specialist diagnosis carried out?

An essential method in the diagnosis has the measurement of pressure by Holter.

This is a measurement of pressure for 24 hours, for which a small device attached to the body of a person is used. He repeatedly measures and records blood pressure values.

There is a pressure gauge cuff attached to the arm and a pressure gauge on the body. This is programmed to measure the pressure at specific time intervals.

The person keeps a diary. As the blood pressure level needs to be assessed in relation to daily activity.

Otherwise, this form of examination is also called:

• ambulatory blood pressure monitoring
• Holter-type ambulatory blood pressure monitoring
• ambulatory blood pressure
• blood pressure holter

Lump-sum blood pressure monitoring for each person is impractical and would burden specialist outpatient clinics. It should be carried out mainly in people who already have associated cardiovascular, cerebrovascular and other diseases.

Alternatively, it is relevant in people who have health problems related to low or high blood pressure. Similarly, it should be done in overweight or obese children.

This type of measurement is important for detecting various forms of high or low blood pressure. Examples include white coat phenomenon, masked hypertension, nocturnal hypertension, isolated forms of hypertension, and others.

In addition to this method, home monitoring of blood pressure is also important.

What can we do for better diagnosis?

Along with the method of outpatient blood pressure monitoring, home blood pressure monitoring is also of great importance.

This is the measurement of blood pressure in the home environment.

A person measures his/her blood pressure at home and records the pressure readings. Apart from the readings, it is important to note down the time and activity that affects the blood pressure.

Home blood pressure monitoring is especially important for people who are already being treated for hypertension or have other conditions that affect blood pressure levels.

In this case, the check should be regular.

One should, of course, measure blood pressure when health problems occur.

Or when a reassessment of the treatment is needed in cooperation with the doctor.

High blood pressure is a disease that is treatable but cannot be cured. Age and a number of other factors also influence its course.

Depending on this, pressure values may gradually increase even if treatment has already been prescribed.

Remember, when measuring blood pressure at home, certain principles are important:

• measuring blood pressure with a certified device
• measurement of blood pressure at the shoulder, using a suitable cuff
• wrist blood pressure monitors are unreliable
• measuring blood pressure in a quiet environment
• sitting up for at least 5 minutes and then measuring blood pressure
• rest for at least 30 minutes or more after heavy physical activity
• do not talk, smoke, move or drink alcohol during the measurement
• avoid stress before the measurement or measure after calming down
• cuff at heart level
• measure on the upper limb where higher blood pressure readings are repeatedly taken
• clothing around the shoulder should not pinch the limb above the cuff
• measuring pressure before taking medication
• two measurements one minute apart - the second is the guideline value, there is no need to take an average
• if the difference is too great, a third measurement
• if there is a significant arrhythmia, the pressure reading will be inaccurate
  • a professional examination with an ECG should be added

Plus.

Daily pressure measurements without a purpose are not recommended.

It unnecessarily burdens and stresses a person.

The opposite is the situation...

Purposeful measurement and the need to evaluate blood pressure with a doctor.

In that case, it is done according to his instructions or as follows:

1. measurement at least 7 days a week
2. measurement every day
3. measurements in the morning and evening or when there is a health problem
4. before taking medication
5. keeping a diary
   • writing down the times
   • activities
   • if necessary, health problems during measurements

Home measurement is also useful because it removes the effect of the hospital environment and the stress of the doctor.

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Don't forget that...

A quality blood pressure monitor is important for home blood pressure measurement!

This should meet certain conditions such as:

• a certified and registered device
• purchased from a pharmacy
  • or online from a verified e-shop
• a calibrated device
• shoulder pressure gauge
• should include a cuff for different arm sizes
• automatic device
• simple operation
• pressure measurement at the heart
• detection of arrhythmia - irregular heartbeat - is also suitable
• recording of time and result
• sufficient battery life, plus measurement with adapter
• travel case
• the latest blood pressure monitors are able to transmit information to the phone via an app
  • app can evaluate and alert

Home + ambulatory pressure measurement

The physician's job is to evaluate the outpatient monitoring afterwards. This is when it is useful if the patient also has their home blood pressure measurement.

It compares the values and information from both methods.