Masked Hypertension
Masked hypertension refers to high blood pressure that doesn't show up when measured in the doctor's office. Readings there are normal, while blood pressure readings in everyday life or at work are in the hypertensive range.
Masked hypertension is the classic form of high blood pressure caused by stress (stress-induced hypertension). Elevated blood pressure readings occur during a highly stressful workday, even though blood pressure is normal at rest (for example, in the doctor's office) and also responds normally to standardized physical exertion. This discrepancy between high blood pressure during mental strain and a normal blood pressure response during physical exertion is characteristic of masked hypertension.
Therefore, the only way to detect masked hypertension is ambulatory long-term blood pressure monitoring with a device worn for a certain period during daily life that takes regular measurements and records the readings, or self-measurement of blood pressure during daily life.
Elevated blood pressure readings during self-measurement may indicate masked hypertension. High-normal readings at the doctor's office should also raise suspicion-especially in younger, relatively slim people. This is particularly true when psychosocial stress factors, alcohol consumption or smoking are also present. In this situation, men are more commonly affected by masked hypertension, even if they are slightly overweight. However, masked hypertension can also occur in people with hypertension who are already receiving treatment and-if their blood pressure readings at the doctor's office are normal-give the false impression that treatment has been successful.
If there are typical signs of organ damage that can be caused by high blood pressure, for example atrial fibrillation, enlargement of an atrium, or enlargement of the left ventricle, a 24-hour or ambulatory blood pressure measurement should also be tried to unmask possible masked hypertension, even if office blood pressure is normal.
The main approach to treating masked hypertension, as the classic stress-induced form, is to reduce stress. Whether medication is needed depends on how severe the high blood pressure is. If organ damage is already present, medication will usually be necessary. The drug treatment itself does not differ from treatment for ordinary high blood pressure.
One study showed that masked hypertension occurs about twice as often as so-called white-coat hypertension, where office readings are higher than everyday readings.
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This article is from Tensana – the leading app since 2011, helping hundreds of thousands of people monitor their blood pressure every day.
Our content is based on carefully researched, evidence-based data and is continuously updated (as of 11/2025).
Author Sabine Croci is a qualified medical assistant with many years of experience in internal medicine and cardiology practices as well as outpatient care, and has headed the specialist editorial team at Tensana since 2015. Thanks to her extensive additional qualifications as an emergency medical technician, first responder, and in various areas of therapy and emergency care, she provides well-founded, practical, and reliably verified information.
Author Sabine Croci is a qualified medical assistant with many years of experience in internal medicine and cardiology practices as well as outpatient care, and has headed the specialist editorial team at Tensana since 2015. Thanks to her extensive additional qualifications as an emergency medical technician, first responder, and in various areas of therapy and emergency care, she provides well-founded, practical, and reliably verified information.
