Left ventricular diastolic function evaluated by the E/e′ ratio is impaired in patients with masked uncontrolled hypertension

Background: Masked uncontrolled hypertension (MUH), defined as controlled office blood pressure (BP) but uncontrolled out-of-office BP in treated hypertensives, is a risk factor for cardiovascular disease. We tested the hypothesis that MUH is associated with a greater degree of diastolic dysfunction than controlled hypertension (CH) or uncontrolled hypertension (UH). Methods and results: We studied 299 treated patients who had at least one cardiovascular risk factor (age, 63 +/- 10 years; male sex, 43%), consisting of 94 (31.4%) patients with UH, 46 (15.4%) with MUH, 56 (18.7%) with treated white-coat hypertension (WCH), and 103 (34.4%) with CH. We performed office and home BP monitoring, electrocardiography, echocardiography and blood tests. Diastolic dysfunction was defined as an E-wave to e'-wave (E/e') ratio >= 8 measured by Doppler echocardiography. The value of E/e' was higher in the MUH (8.3 +/- 2.7) and UH (8.3 +/- 2.7) groups than in the CH group (7.3 +/- 2.3; p +/- 0.08, p = 0.02, respectively). In multivariable analysis, MUH was associated with a significantly higher likelihood of diastolic dysfunction than CH (odds ratio 2.90 versus CH, p<0.01) after adjusting for significant covariates. Conclusions: MUH and UH were associated with a greater degree of diastolic dysfunction than CH. Even in treated patients, out-of-office BP is important to stratify the risk of cardiovascular disease.