It looks fine at the doctor's office — and spikes at home. A type of high blood pressure that hides from routine check-ups, known as masked hypertension, has now been linked to a sharply higher risk of falls in older adults, according to preliminary research presented at the American Heart Association's Hypertension Scientific Sessions this month.
Researchers analysed data from 758 adults aged 78 to 98 taking part in the long-running Atherosclerosis Risk in Communities (ARIC) study. Each participant had their blood pressure measured both ways: three seated readings in a clinic, and repeated morning and evening readings at home over eight non-consecutive days in 2023. Eighty-two percent were already taking blood pressure medication. Falls were then tracked over a year, using participants' reports collected in annual phone calls.
Nearly one in four participants — 23.4 percent — reported at least one fall in the previous 12 months. About 15.4 percent of the group turned out to have masked hypertension: normal readings in the office, elevated readings at home. Those participants had a 70 percent higher risk of falls than people with sustained hypertension, whose blood pressure was high in both settings.
Why a hidden condition is dangerous
Masked hypertension is dangerous precisely because it is invisible to the standard check-up. A patient whose clinic readings look controlled may be living with elevated pressure the rest of the day — untreated or under-treated — while neither they nor their doctor sees a reason to act. Falls, meanwhile, are among the most serious health risks in this age group, frequently leading to fractures, hospitalisation and loss of independence.
The researchers stress that the findings are preliminary and have not yet completed peer review, and the study shows an association rather than proving that masked hypertension causes falls. Blood pressure that surges and dips through the day, or medication effects interacting with those swings, are among the possible explanations scientists want to explore.
Why it matters, and what happens next
The practical message is that a single office reading may not be enough for older patients: home blood pressure monitoring — cheap, widely available and already recommended in many guidelines — is the only way masked hypertension gets found. If the link to falls holds up in peer-reviewed follow-up work, home readings could become a standard part of fall-prevention checks for people in their late seventies and beyond, alongside vision, medication reviews and balance assessments.
Reporting based on the American Heart Association's Hypertension Scientific Sessions presentation and coverage of the ARIC analysis.