Lifestyle Modification for Masked Hypertension

Masked hypertension is commonly seen in treated and untreated individuals and has been shown to be associated with target organ damage and poor cardiovascular prognosis. Although the etiology of masked hypertension appears to be complex, several lifestyle-related factors not only play important roles in the pathophysiology of essential hypertension but are also related to masked hypertension. Masked hypertension can be classified according to the 24-hour blood pressure profile. Morning hypertension may be caused by evening alcohol consumption, mental and physical stress, and the morning use of short-acting antihypertensive drugs. Daytime hypertension is related to habitual smoking and mental and physical stress. Nighttime hypertension is seen in various conditions including a high salt intake, renal dysfunction, obesity, sleep apnea, and autonomic failure. Therefore, lifestyle modifications are effective in the treatment of masked hypertension. Alcohol restriction is expected to lower morning blood pressure, smoking cessation and stress management preferably lower daytime blood pressure, and sodium restriction and weight reduction may be effective to control nighttime blood pressure. It is important to identify the subtype and related factor(s) for each individual with masked hypertension, and to treat each patient appropriately according to the cause of masked hypertension.