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In this review, we describe target organ damage and cardiovascular events in masked hypertension. Masked hypertension is associated with more target organ damage, including sustained hypertension, left ventricular hypertrophy, carotid atherosclerosis, microalbuminuria, silent cerebral infarct, arterial stiffness, central blood pressure and obstructive sleep apnea, than is sustained normotension. Masked hypertension represents a strong predictor of cardiovascular morbidity and mortality in diverse patient groups including diabetics and patients with prehypertension. Therefore, clinicians should pursue the diagnosis of masked hypertension in individuals at increased cardiovascular risk and follow patients with prehypertension, encouraging out-of-office monitoring of blood pressure.