239 Should we screen masked hypertension in patients with vascular disease?

ObjectiveIn this study we investigated the interest to detect masked hypertension (MH) in a population of patients with no prior history of hypertension, at very high cardiovascular risk and who received hypotensive medications prescribed for their vascular disease, as angiotensin- converting enzyme inhibitor (ACE).Design and MethodIn this prospective study, 38 patients were send to our unit for the realisation of a coronarography or an arteriography. Subjects have no prior history of hypertension, with a blood pressure (BP) at admission under 140/90mmHg, and documented vascular disease. They underwent a 24-h ambulatory BP monitoring(ABMP) after discharge. Subjects who showed normotension at admission and an ambulatory BP under 125/80mmHg on the 24-h ABMP were considered as normotensive (NT). Subjects who showed normotension at admission and an ambulatory BP upper or equal to 125/80mmHg were defined as MH.ResultsMH was found in 11 patients, represented 28.9% of our population. The prevalence of MH was significantly higher in subjects whose mean systolic BP and mean diastolic BP (127.2mmHg vs 115.8mmHg, p=0.002 and 76.1mmHg vs 66.6mmHg, p=0.01) during the hospitalisation than the confirmed NT did. At admission the systolic BP and the pulse pressure tend to be higher in the MH group than in the NT group (127.5mmHg vs 121mmHg, p= 0.07 and 54.5mmHg vs 46.7mmHg,p=0.06). The first measurement of blood pressure of the 24-h ABPM, who was considered as a pressure of consultation, was significantly higher in the MH group than in the NT group (140mmHg vs 121mmHg, p=0.001 for the systolic BP and 84mmHg vs 74mmHg, p=0.03, for the diastolic BP).ConclusionsMH is frequent in our population with a documented vascular disease under medication, with no prior history of hypertension. The screening of MH hypertension in this population seems to be necessary. The pre hypertensive rank seems to be a good predictor of MH