Prevalence, Determinants, and Clinical Significance of Masked Hypertension in a Population-Based Sample of African Americans: The Jackson Heart Study

Am J Hypertens. 2015 Jul;28(7):900-8. doi: 10.1093/ajh/hpu241. Epub 2014 Dec 12.


Background: The disproportionate rates of cardiovascular disease in African Americans may, in part, be due to suboptimal assessment of blood pressure (BP) with clinic BP measurements alone. To date, however, the prevalence of masked hypertension in African Americans has not been fully delineated. The purpose of this study was to evaluate masked hypertension prevalence in a large population-based sample of African Americans and examine its determinants and association with indices of target organ damage (TOD).

Methods: Clinic and 24-hour ambulatory BP monitoring were conducted in 972 African Americans enrolled in the Jackson Heart Study. Common carotid artery intima-media thickness, left ventricular mass index, and the urinary albumin:creatinine excretion ratio were evaluated as indices of TOD.

Results: Masked hypertension prevalence was 25.9% in the overall sample and 34.4% in participants with normal clinic BP. All indices of TOD were significantly higher in masked hypertensives compared to sustained normotensives and were similar between masked hypertensives and sustained hypertensives. Male gender, smoking, diabetes, and antihypertensive medication use were independent determinants of masked hypertension in multivariate analyses.

Conclusions: In this population-based cohort of African Americans, approximately one-third of participants with presumably normal clinic BP had masked hypertension when BP was assessed in their daily environment. Masked hypertension was accompanied by a greater degree of TOD in this cohort.

Keywords: African Americans; ambulatory blood pressure monitoring; blood pressure; hypertension; masked hypertension; target organ damage..

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Antihypertensive Agents / therapeutic use
  • Black or African American*
  • Blood Pressure Monitoring, Ambulatory
  • Blood Pressure* / drug effects
  • Carotid Artery Diseases / diagnostic imaging
  • Carotid Artery Diseases / ethnology
  • Carotid Artery Diseases / physiopathology
  • Carotid Artery, Common / diagnostic imaging
  • Carotid Intima-Media Thickness
  • Diabetes Mellitus / ethnology
  • Disease Progression
  • Female
  • Humans
  • Hypertrophy, Left Ventricular / diagnostic imaging
  • Hypertrophy, Left Ventricular / ethnology
  • Hypertrophy, Left Ventricular / physiopathology
  • Kidney Diseases / diagnosis
  • Kidney Diseases / ethnology
  • Kidney Diseases / physiopathology
  • Logistic Models
  • Male
  • Masked Hypertension / diagnosis
  • Masked Hypertension / drug therapy
  • Masked Hypertension / ethnology*
  • Masked Hypertension / physiopathology
  • Middle Aged
  • Mississippi / epidemiology
  • Multivariate Analysis
  • Odds Ratio
  • Prevalence
  • Risk Factors
  • Sex Factors
  • Smoking / adverse effects
  • Smoking / ethnology


  • Antihypertensive Agents