Superioridad del monitoreo ambulatorio de presión arterial sobre la medición en consultorio para la detección de hipertensión enmascarada: Una revisión integrativa
DOI:
https://doi.org/10.66476/mf.v2n2.6276Palabras clave:
hipertensión enmascarada, monitoreo ambulatorio de presión arterial, hipertensión de bata blanca, riesgo cardiovascular, diagnósticoResumen
Introducción: La hipertensión arterial es un factor de riesgo cardiovascular prevalente, pero su diagnóstico tradicional mediante medición en consultorio presenta baja sensibilidad. La hipertensión enmascarada, caracterizada por presión normal en clínica y elevada en el entorno ambulatorio, conlleva un riesgo similar a la hipertensión sostenida.
Objetivo: Analizar la precisión diagnóstica del monitoreo ambulatorio de presión arterial (MAPA) frente a la medición en consultorio para la detección de hipertensión enmascarada y evaluar su impacto clínico.
Métodos: Se realizó una revisión integrativa bajo el marco de Whittemore y Knafl. Se analizaron estudios observacionales y ensayos clínicos publicados entre 2005 y 2024 en bases de datos biomédicas (PubMed, Scopus), centrados en adultos con discrepancias de presión arterial.
Resultados: La medición en consultorio mostró una sensibilidad limitada (60-70 %) para descartar hipertensión enmascarada, cuya prevalencia osciló entre el 10 % y el 47 % según el riesgo poblacional. El MAPA identificó marcadores fisiopatológicos críticos como la hipertensión nocturna y el patrón non-dipper, asociados a mayor daño de órgano blanco (hipertrofia ventricular izquierda, rigidez arterial).
Conclusiones: El MAPA es el estándar de referencia indispensable para superar la inercia terapéutica en pacientes con fenotipos de riesgo (obesidad, diabetes, enfermedad renal). Su implementación sistemática es costo-efectiva al prevenir eventos cardiovasculares mayores.
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Dolan E, Stanton A, Thijs L, Hinedi K, Atkins N, McClory S, et al. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study: The Dublin outcome study. Hypertension. 2005 Jul;46(1):156–61. https://doi.org/10.1161/01.hyp.0000170138.56903.7a
Sova M, Genzor S, Sovova M, Sovova E, Moravcova K, Nadjarpour S, et al. High incidence of masked hypertension in patients with obstructive sleep apnoea despite normal automated office blood pressure measurement results. Adv Respir Med. 2020;88(6):567–73. https://doi.org/10.5603/arm.a2020.0198
Groenland EH, Vendeville JPAC, Bemelmans RHH, Monajemi H, Bots ML, Visseren FLJ, et al. Smartphone application-assisted home blood pressure monitoring compared with office and ambulatory blood pressure monitoring in patients with hypertension: The AMUSE-BP study. Hypertension. 2022 Oct;79(10):2373–82. https://doi.org/10.1161/hypertensionaha.122.19685
Gao W, Jin Y, Bao T, Huang Y. Comparison of ambulatory blood pressure monitoring and office blood pressure in primary health care of populations at a high risk of hypertension. Front Public Health. 2022;10:985730. https://doi.org/10.3389/fpubh.2022.985730
Demiray A, Kanbay M. The assessment of hypertension in kidney transplant patients: time to change our approach? Clin Kidney J. 2022 Jan;15(1):1–4. https://doi.org/10.1093/ckj/sfab151
Huang QF, Yang WY, Asayama K, Zhang ZY, Thijs L, Li Y, et al. Ambulatory Blood Pressure Monitoring to Diagnose and Manage Hypertension. Hypertension. 2021 Feb;77(2):254–64. https://doi.org/10.1161/hypertensionaha.120.14591
Ahmed J, Ozorio V, Farrant M, Van Der Merwe W. Ambulatory vs office blood pressure monitoring in renal transplant recipients. J Clin Hypertens (Greenwich). 2015 Jan;17(1):46–50. https://doi.org/10.1111/jch.12448
Cheng Y, Li Y, Wang J. Ambulatory blood pressure monitoring for the management of hypertension. Chin Med J (Engl). 2022 May 5;135(9):1027–35. https://doi.org/10.1097/cm9.0000000000002028
Cohen JB, Cohen DL. Integrating out-of-office blood pressure in the diagnosis and management of hypertension. Curr Cardiol Rep. 2016 Nov;18(11):112. https://doi.org/10.1007/s11886-016-0780-3
Mahmud A, Alahaideb R, Alshammary H, Abanumay M, Alfawwaz A, Alhelabi S, et al. Prevalence and clinical correlates of ambulatory blood pressure phenotypes in a Saudi hypertensive population. J Clin Hypertens (Greenwich). 2020 Dec;22(12):2372–6. https://doi.org/10.1111/jch.14059
Akbay E, Çoner A, Akinci S, Adar A, Çakan F, Müderrisoğlu H. Aortic arch calcification: a novel parameter for prediction of masked hypertension: a novel parameter for prediction of masked hypertension. Blood Press Monit. 2021 Aug;26(4):257–62. https://doi.org/10.1097/mbp.0000000000000529
Stergiou GS, Asayama K, Thijs L, Kollias A, Niiranen TJ, Hozawa A, et al. Prognosis of white-coat and masked hypertension: International Database of HOme blood pressure in relation to Cardiovascular Outcome: International Database of home blood pressure in relation to cardiovascular outcome. Hypertension. 2014 Apr;63(4):675–82. https://doi.org/10.1161/hypertensionaha.113.02741
Singh M, Singh N, Pahuja H, Arora R, Anshul, Patel H. White Coat Effect: Is it because of the hospital setting, or is it physician-induced? Cureus. 2023 Apr;15(4):e38144. https://doi.org/10.7759/cureus.38144
Park SJ, Park JB, Choi DJ, Youn HJ, Park CG, Ahn YK, et al. Detection of masked hypertension and the “mask effect” in patients with well-controlled office blood pressure. Circ J. 2011;75(2):357–65. https://doi.org/10.1253/circj.cj-10-0492
La Scola C, Marra G, Ammenti A, Pasini A, Taroni F, Bertulli C, et al. Born with a solitary kidney: at risk of hypertension. Pediatr Nephrol. 2020 Aug;35(8):1483–90. https://doi.org/10.1007/s00467-020-04535-1
Nemcsik J, Takács J, Kekk Z, Farsang C, Simon A, Páll D, et al. White-coat effect and masked hypertension in patients with high-normal office blood pressure: results of the Hungarian ABPM Registry. J Hypertens. 2024 Nov 1;42(11):1976–84. https://doi.org/10.1097/hjh.0000000000003825
Rhee MY, Kim SW, Choi EH, Kim JH, Nah DY, Shin SJ, et al. Prevalence of masked hypertension: A population-based survey in a large city by using 24-hour ambulatory blood pressure monitoring. Korean Circ J. 2016 Sep;46(5):681–7. https://doi.org/10.4070/kcj.2016.46.5.681
Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005 Dec;52(5):546–53. https://doi.org/10.1111/j.1365-2648.2005.03621.x
Siddiqui M, Judd EK, Jaeger BC, Bhatt H, Dudenbostel T, Zhang B, et al. Out-of-clinic sympathetic activity is increased in patients with masked uncontrolled hypertension. Hypertension. 2019 Jan;73(1):132–41. https://doi.org/10.1161/hypertensionaha.118.11818
Gómez-Berrocal A, De Los Santos-Gil I, Abad-Pérez D, Gutiérrez-Liarte Á, Ibáñez-Sanz P, Sanz-Sanz J, et al. Ambulatory blood pressure monitoring in HIV-infected patients: Usefulness for cardiovascular risk assessment. J Int Assoc Provid AIDS Care. 2020 Jan;19:2325958220935693. https://doi.org/10.1177/2325958220935693
Strumph K, Hafeman M, Ranabothu S, Gomes W, Benitez S, Kaskel F, et al. Nocturnal hypertension associated with stroke and silent cerebral infarcts in children with sickle cell disease. Pediatr Blood Cancer. 2021 May;68(5):e28883. https://doi.org/10.1002/pbc.28883
Larsen TR, Gelaye A, Waanbah B, Assad H, Daloul Y, Williams F, et al. Prevalence of masked hypertension in African Americans. J Clin Hypertens (Greenwich). 2014 Nov;16(11):801–4. https://doi.org/10.1111/jch.12418
Thomopoulos C, Papadopoulos DP, Papazachou O, Bratsas A, Massias S, Anastasiadis G, et al. Free leptin is associated with masked hypertension in nonobese subjects: a cross-sectional study: A cross-sectional study. Hypertension. 2009 Jun;53(6):965–72. https://doi.org/10.1161/hypertensionaha.108.128041
Uzu T, Nakao K, Kume S, Araki H, Isshiki K, Araki SI, et al. High sodium intake is associated with masked hypertension in Japanese patients with type 2 diabetes and treated hypertension. Am J Hypertens. 2012 Nov;25(11):1170–4. https://doi.org/10.1038/ajh.2012.102
Ambatiello LG, Bravaya AI, Rogoza AN, Chazova IE. Stress-induced arterial hypertension: search for predictors. Syst Hypertens. 2024 Oct 27;21(3):5–13. https://doi.org/10.38109/2075-082x-2024-2-5-13
Viera AJ, Lin FC, Tuttle LA, Olsson E, Girdler SS, Hinderliter AL. Examination of several physiological and psychosocial factors potentially associated with masked hypertension among low-risk adults. J Clin Hypertens (Greenwich). 2016 Aug;18(8):784–9. https://doi.org/10.1111/jch.12761
Abdalla M, Booth JN 3rd, Seals SR, Spruill TM, Viera AJ, Diaz KM, et al. Masked hypertension and incident clinic hypertension among blacks in the Jackson Heart Study. Hypertension. 2016 Jul;68(1):220–6. https://doi.org/10.1161/hypertensionaha.115.06904
Pierdomenico SD, Pierdomenico AM, Coccina F, Clement DL, De Buyzere ML, De Bacquer DA, et al. Prognostic value of masked uncontrolled hypertension: Systematic review and meta-analysis. Hypertension. 2018 Oct;72(4):862–9. https://doi.org/10.1161/hypertensionaha.118.11499
Yam MC, So HK, Kwok SY, Lo FC, Mok CF, Leung CK, et al. Left ventricular mass of persistent masked hypertension in Hong Kong Chinese adolescents: a 4-year follow-up study. Cardiol Young. 2018 Apr 22;28(6):1–7. https://doi.org/10.1017/s1047951118000434
Hinderliter AL, Lin FC, Viera LA, Olsson E, Klein JL, Viera AJ. Hypertension-mediated organ damage in masked hypertension. J Hypertens. 2022 Apr 1;40(4):811–8. https://doi.org/10.1097/hjh.0000000000003084
Stabouli S, Kotsis V, Toumanidis S, Papamichael C, Constantopoulos A, Zakopoulos N. White-coat and masked hypertension in children: association with target-organ damage. Pediatr Nephrol. 2005 Aug;20(8):1151–5. https://doi.org/10.1007/s00467-005-1979-5
Mancia G, Bombelli M, Facchetti R, Madotto F, Quarti-Trevano F, Polo Friz H, et al. Long-term risk of sustained hypertension in white-coat or masked hypertension. Hypertension. 2009 Aug;54(2):226–32. https://doi.org/10.1161/hypertensionaha.109.129882
de la Sierra A, Vinyoles E, Banegas JR, Parati G, de la Cruz JJ, Gorostidi M, et al. Short-term and long-term reproducibility of hypertension phenotypes obtained by office and ambulatory blood pressure measurements. J Clin Hypertens (Greenwich). 2016 Sep;18(9):927–33. https://doi.org/10.1111/jch.12792
Zaninelli A, Parati G, Cricelli C, Bignamini AA, Modesti PA, Pamparana F, et al. Office and 24-h ambulatory blood pressure control by treatment in general practice: the “Monitoraggio della pressione ARteriosa nella medicina TErritoriale” study. J Hypertens. 2010 May;28(5):910–7. https://doi.org/10.1097/hjh.0b013e32833778cc
Pickering TG, Davidson K, Gerin W, Schwartz JE. Masked hypertension. Hypertension. 2002 Dec;40(6):795–6. https://doi.org/10.1161/01.hyp.0000038733.08436.98
Green MB, Shimbo D, Schwartz JE, Bress AP, King JB, Muntner P, et al. Cost-effectiveness of masked hypertension screening and treatment in US adults with suspected masked hypertension: A simulation study. Am J Hypertens. 2022 Aug 1;35(8):752–62. https://doi.org/10.1093/ajh/hpac071
Wang YC, Koval AM, Nakamura M, Newman JD, Schwartz JE, Stone PW. Cost-effectiveness of secondary screening modalities for hypertension. Blood Press Monit. 2013 Feb;18(1):1–7. https://doi.org/10.1097/mbp.0b013e32835d0fd3
Poudel B, Viera AJ, Shimbo D, Schwartz JE, Shikany JM, Sakhuja S, et al. Comparison of the association of masked hypertension defined by the 2017 ACC/AHA BP guideline versus the JNC7 guideline with left ventricular hypertrophy. J Hypertens. 2022 Aug 1;40(8):1597–606. https://doi.org/10.1097/hjh.0000000000003192
Veerabhadrappa P, Diaz KM, Feairheller DL, Sturgeon KM, Williamson ST, Crabbe DL, et al. Endothelial-dependent flow-mediated dilation in African Americans with masked-hypertension. Am J Hypertens. 2011 Oct;24(10):1102–7. https://doi.org/10.1038/ajh.2011.103
van der Heijden LB, Groothoff JW, Feskens EJ, Janse AJ. Office blood pressure versus ambulatory blood pressure measurement in childhood obesity. BMC Pediatr. 2023 Apr 29;23(1):205. https://doi.org/10.1186/s12887-023-04010-4
Parati G, Pengo MF, Avolio A, Azizi M, Bothe TL, Burnier M, et al. Nocturnal blood pressure: pathophysiology, measurement and clinical implications. Position paper of the European Society of Hypertension. J Hypertens. 2025 Aug 1;43(8):1296–318. https://doi.org/10.1097/hjh.0000000000004053
Pickering TG, Eguchi K, Kario K. Masked hypertension: a review. Hypertens Res. 2007 Jun;30(6):479–88. https://doi.org/10.1291/hypres.30.479
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Derechos de autor 2025 Liz Vanessa Vega, Charles Daniel Sosa, Richiar Ramón Peña Rojas, Maísa Mendes Cumerlatto, André Luís de Souza Beloni, Barbara Suelen Lobos Vera, Karen Andrea Sosa Blanco
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
Los artículos se distribuyen bajo licencia Creative Commons Atribución 4.0 Internacional — CC BY 4.0. Los autores conservan los derechos de autor y otorgan a la revista el derecho de primera publicación. Cualquier reutilización debe reconocer la autoría, citar la fuente original e indicar si se realizaron modificaciones.
