Silent but Serious: What Every Clinician Should Know About Masked Hypertension
You’ve likely seen this in clinic. A patient checks in with a blood pressure of 128/72 mm Hg. Nothing jumps out. But after you recommend home monitoring, they return with readings averaging 142/84. That should raise your suspicion.
This is masked hypertension (MH), and it’s a condition that often flies under the radar but carries real risk. And it's showing up more in headlines, clinical discussions and evidence-based guidelines.
Recent estimates suggest that 1 in 6 U.S. adults may have masked hypertension. The American Medical Association has called it a “blind spot” in routine care. Meanwhile in 2025, JAMA Cardiology reported that about 18% of U.S. adults with hypertension are unaware they have it—with a notable rise among younger adults ages 20–44, underscoring how masked hypertension remains underdiagnosed in clinical practice.
What Exactly Is Masked Hypertension?
Here’s the clinical definition:
- Normal blood pressure in the office (<130/80 mm Hg)
- Elevated blood pressure outside the office (≥125/75 mm Hg with ambulatory BP monitoring (ABPM), or ≥130/80 mm Hg at home)
It’s essentially the inverse of white coat hypertension. The patient relaxes in your office and shows a normal BP, but that doesn’t reflect his or her true burden of pressure throughout the day. And here’s the catch: it’s not benign.
Physician experts say MH carries a 1.7x increased risk of cardiovascular events compared to sustained normotension. It’s been linked to target organ damage—microalbuminuria, left ventricular hypertrophy, and even stroke.
Why It’s Gaining Traction Now
Several forces are at play:
- Guideline updates: The 2017 ACC/AHA hypertension guidelines encourage out-of-office BP monitoring, especially in borderline cases.
- Greater awareness: Global campaigns like World Hypertension Day have emphasized the importance of detecting silent hypertension.
- Demographic shift: More 30- and 40-year-olds are being diagnosed with MH, often due to lifestyle factors, stress, and subclinical disease.
Given its rising prevalence and diagnostic complexity, it’s no surprise that MH gets special focus in the latest update from ACP MKSAP Audio Companion, framed through practical case discussion and evidence-backed interpretation.
Where the ACP MKSAP Audio Companion Comes In
If you're managing outpatient hypertension or reviewing for the boards, this is where ACP MKSAP Audio delivers real clinical value.
In the latest update, you'll walk through a case that mirrors the scenario many clinicians face:
- A patient with high-normal office BP, but elevated readings at home
- Clinical reasoning behind when to order ABPM vs. self-measured blood pressure (SMBP)
- How to interpret findings within current ACC/AHA thresholds
- Tips on counseling, recommending lifestyle modifications, and knowing when medication is warranted
This isn’t just test prep. It’s applied clinical thinking, grounded in everyday practice. And the format makes it easy to fit into your workflow whether you're between patients or driving home.
Bottom Line: Don’t Miss What the Cuff Can’t Tell You
Masked hypertension reminds us that not all "normal" readings are reassuring. It’s a diagnosis that requires vigilance, and one that’s increasingly relevant across patient populations.
The ACP MKSAP Audio Companion is built to support that vigilance by reinforcing core clinical principles and sharpening your judgment through cases you’ll actually encounter. You’ll get the why, the how, and the what-next.
Listen. Learn. Stay one step ahead. Start your ACP MKSAP Audio journey today!