Sex differences in masked hypertension: The Coronary Artery Risk Development in Young Adults study

Daniel N. Pugliese*, John N. Booth, Luqin Deng, D. Edmund Anstey, Natalie A. Bello, Byron C. Jaeger, James M. Shikany, Donald Lloyd-Jones, Cora E. Lewis, Joseph E. Schwartz, Paul Muntner, Daichi Shimbo

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective:To evaluate the association of sex with masked hypertension, defined by out-of-clinic hypertension based on ambulatory blood pressure monitoring (ABPM) among adults without hypertension based on blood pressure (BP) measured in the clinic, after adjusting for potential confounders.Methods:We evaluated sex differences in the prevalence of masked hypertension and the difference between awake, or alternatively 24-h, ambulatory BP and clinic BP using multivariable adjusted models among 658 participants who underwent 24-h ABPM and had clinic SBP/DBP less than 140/90 mmHg during the Year 30 Exam of the Coronary Artery Risk Development in Young Adults study.Results:The mean age ± standard deviation (SD) of the participants was 54.8 ± 3.7 years, 58.4% were women, and 58.2% were black. The prevalence of any masked hypertension was 37.5% among women and 60.6% among men. In a model including adjustment for demographics, cardiovascular risk factors, antihypertensive medication, and clinic BP, the prevalence ratios (95% confidence intervals) comparing men versus women were 1.39 (1.18-1.63) for any masked hypertension, and 1.60 (1.28-1.99), 1.71 (1.36-2.15), and 1.40 (1.13-1.73) for masked awake, 24-h and asleep hypertension, respectively. In a fully adjusted model, the differences between mean awake ambulatory BP and clinic BP were 2.75 [standard error (SE) 0.92] mmHg higher for SBP and 3.61 (SE 0.58) mmHg higher for DBP among men compared with women.Conclusion:The prevalence of masked hypertension on ABPM was high in both men and women. Male sex was an independent predictor of masked hypertension.

Original languageEnglish (US)
Pages (from-to)2380-2388
Number of pages9
JournalJournal of hypertension
Issue number12
StatePublished - Dec 1 2019


  • ambulatory
  • blood pressure monitoring
  • hypertension
  • masked hypertension
  • sex

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine


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