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Hypertension. 2016 Jun;67(6):1249-55. doi: 10.1161/HYPERTENSIONAHA.116.07242. Epub 2016 Apr 11.

Prevalence and Determinants of Masked Hypertension Among Black Nigerians Compared With a Reference Population.

Author information

1
From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (A.N.O., L.T., A.H., F.-F.W., L.J., J.A.S.); Department of Internal Medicine, Faculty of Clinical Sciences (A.N.O.), Department of Human Physiology (J.O.O.), and Department of Chemical Pathology (M.M.N.), Faculty of Basic Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, Nigeria; Hospital Italiano de Buenos Aires, Buenos Aires, Argentina (L.S.A.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Department of Health, National Institute for Health and Welfare, Turku, Finland (T.J.N., J.K.J., A.M.J.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B., L.L.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (G.S.S); Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland (E.O.); and R & D Group VitaK, Maastricht University, Maastricht, The Netherlands (J.A.S.).
2
From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (A.N.O., L.T., A.H., F.-F.W., L.J., J.A.S.); Department of Internal Medicine, Faculty of Clinical Sciences (A.N.O.), Department of Human Physiology (J.O.O.), and Department of Chemical Pathology (M.M.N.), Faculty of Basic Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, Nigeria; Hospital Italiano de Buenos Aires, Buenos Aires, Argentina (L.S.A.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Department of Health, National Institute for Health and Welfare, Turku, Finland (T.J.N., J.K.J., A.M.J.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B., L.L.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (G.S.S); Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland (E.O.); and R & D Group VitaK, Maastricht University, Maastricht, The Netherlands (J.A.S.). jan.staessen@med.kuleuven.be.

Abstract

Hitherto, diagnosis of hypertension in sub-Saharan Africa was largely based on conventional office blood pressure (BP). Data on the prevalence of masked hypertension (MH) in this region is scarce. Among individuals with normal office BP (<140/90 mm Hg), we compared the prevalence and determinants of MH diagnosed with self-monitored home blood pressure (≥135/85 mm Hg) among 293 Nigerians with a reference population consisting of 3615 subjects enrolled in the International Database on Home Blood Pressure in Relation to Cardiovascular Outcomes. In the reference population, the prevalence of MH was 14.6% overall and 11.1% and 39.6% in untreated and treated participants, respectively. Among Nigerians, the prevalence standardized to the sex and age distribution of the reference population was similar with rates of 14.4%, 8.6%, and 34.6%, respectively. The mutually adjusted odds ratios of having MH in Nigerians were 2.34 (95% confidence interval, 1.39-3.94) for a 10-year higher age, 1.92 (1.11-3.31) and 1.70 (1.14-2.53) for 10- or 5-mm Hg increments in systolic or diastolic office BP, and 3.05 (1.08-8.55) for being on antihypertensive therapy. The corresponding estimates in the reference population were similar with odds ratios of 1.80 (1.62-2.01), 1.64 (1.45-1.87), 1.13 (1.05-1.22), and 2.84 (2.21-3.64), respectively. In conclusion, MH is as common in Nigerians as in other populations with older age and higher levels of office BP being major risk factors. A significant proportion of true hypertensive subjects therefore remains undetected based on office BP, which is particularly relevant in sub-Saharan Africa, where hypertension is now a major cause of death.

KEYWORDS:

home blood pressure monitoring; masked hypertension; special populations

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