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The prevalence of masked hypertension and masked uncontrolled hypertension in relation to overweight and obesity in a nationwide registry in China

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  • Special Issue: Current evidence and perspectives for hypertension management in Asia
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A Comment to this article was published on 09 November 2022

Abstract

Masked hypertension is difficult to identify and is associated with adverse outcomes. How and to what extent masked hypertension is related to overweight and obesity remain unclear. In participants with a clinic blood pressure (BP) < 140/90 mmHg enrolled in a nationwide prospective registry in China, we performed ambulatory and home BP measurements and defined masked hypertension and masked uncontrolled hypertension as an elevated 24-h (≥130/80 mmHg), daytime (≥135/85 mmHg) or nighttime ambulatory BP (≥120/70 mmHg) or an elevated home BP (≥135/85 mmHg). Overweight and obesity were defined as a body mass index of 25.0–29.9 and ≥30.0 kg/m2, respectively. The 2838 participants had a mean (±SD) age of 54.9 ± 13.6 years and included 1286 (45.3%) men and 1065 (37.5%) and 173 (6.1%) patients with overweight and obesity, respectively. Multiple stepwise regression analyses identified that body mass index was significantly (P ≤ 0.006) associated with the prevalence of masked ambulatory and home hypertension in treated (n = 1694, 58.6% and 42.1%, respectively) but not untreated participants (n = 1144, 55.7% and 29.5%, respectively). In categorical analyses, significant associations were observed with overweight and obesity for the prevalence of masked uncontrolled ambulatory and home hypertension (P ≤ 0.02) but not masked ambulatory or home hypertension (P ≥ 0.08). The adjusted odds ratios (95% confidence intervals) for overweight and obesity relative to normal weight were 1.56 (1.27–1.92) and 1.34 (1.09–1.65) for masked uncontrolled ambulatory and home hypertension, respectively. In conclusion, overweight and obesity were associated with a higher prevalence of masked uncontrolled hypertension, indicating that clinic BP might overestimate antihypertensive treatment effects in patients with overweight and obesity.

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Acknowledgements

The authors gratefully acknowledge the study participants and the investigators from all participating hospitals (Online Data Supplement).

Funding

YL and JGW were financially supported by grants from the National Natural Science Foundation of China (91639203, 81770455, 82070432 and 82070435), Ministry of Science and Technology (2018YFC1704902) and Ministry of Health (2016YFC0900902), Beijing, China and from the Shanghai Commissions of Science and Technology (19DZ2340200) and Health (a special grant for “leading academics”), and the Shanghai Shenkang Hospital Development Center (SHDC2020CR1042B), Shanghai, China. DYZ and QHG were supported by grants from the National Natural Science Foundation of China (82100445 and 82000394) and DYZ and YBC by the Shanghai “Sailing” Program (19YF144100 and 21YF1438700).

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Author notes

  1. These authors contributed equally: Jia-Hui Xia, Dong-Yan Zhang

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Jia-Hui Xia, Dong-Yan Zhang, Yuan-Yuan Kang, Qian-Hui Guo, Yi-Bang Cheng, Jian-Feng Huang, Qi-Fang Huang, Wei Zhang, Yan Li & Ji-Guang Wang

  2. Department of Electrocardiography and Cardiac Function, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China

    Li-Juan Zhang

  3. Department of Cardiology, Jiangsu Province Geriatric Hospital, Nanjing, Jiangsu, China

    Yu Dou

  4. Department of Cardiology, Lianyungang Affiliated Hospital of Nanjing University of Chinese Medicine, Lianyungang, Jiangsu, China

    Yan-Lun Su

  5. Department of Hypertension, Zhoukou Central Hospital, Zhoukou, Henan, China

    Hua-Ling Liu

  6. Department of Hypertension, Wuhu Hospital of Chinese Medicine, Wuhu, Anhui, China

    Mei-Sheng Zheng

  7. Department of Hypertension, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China

    Xin-Juan Xu

  8. Department of Cardiology, The First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an, Shaanxi, China

    Jian-Jun Mu

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  1. Jia-Hui Xia
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Correspondence to Ji-Guang Wang.

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JGW reports having received lecture and consulting fees from Novartis, Omron, Servier and Viatris. The other authors declare no conflicts of interest.

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Xia, JH., Zhang, DY., Kang, YY. et al. The prevalence of masked hypertension and masked uncontrolled hypertension in relation to overweight and obesity in a nationwide registry in China. Hypertens Res 45, 1690–1700 (2022). https://doi.org/10.1038/s41440-022-01005-z

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