Masked high blood pressure, a condition where office blood pressure readings appear normal but home measurements are elevated, is associated with a 70% higher risk of falls in adults older than 78 compared with sustained high blood pressure, according to preliminary research presented at the American Heart Association's Hypertension Scientific Sessions 2026. The findings, announced via NEWMEDIAWIRE, highlight a hidden danger for a rapidly growing and under-studied population.
Falls are the leading cause of disability and functional decline in adults age 65 and older, according to the U.S. Centers for Disease Control and Prevention. While low blood pressure has traditionally been viewed as a fall risk, emerging evidence suggests that high home blood pressure may also contribute. The study's results align with the American Heart Association's 2025 Joint Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, which recommends annual monitoring and supports home blood pressure monitoring to confirm diagnoses and tailor care.
"Preventing falls in elderly adults should be a top priority. These findings highlight that, in addition to office blood pressure measurement, home blood pressure readings can be an important way to identify hidden home high blood pressure and risk of falls in older adults," said Frances Wang, Ph.D., M.S., a researcher at Beth Israel Deaconess Medical Center in Boston and the study's presenting author. "Home blood pressure measurement can add helpful health information for older adults and, as shown in findings from prior studies, for most of the general public."
The study analyzed 758 adults aged 78-98 from the Atherosclerosis Risk in Communities (ARIC) study. Among them, 34.5% had sustained high blood pressure, 17.0% had white coat hypertension, 15.4% had masked hypertension, and 33.2% had normal readings. During a median follow-up of 350 days, 23.4% of participants reported falling at least once in the previous 12 months. Notably, white coat hypertension was linked to a lower fall risk compared to sustained high blood pressure.
"These findings confirm that 'normal' office blood pressure isn't always the end of the story," said Karol E. Watson, M.D., Ph.D., FAHA, a volunteer expert for the American Heart Association. "In this study, when blood pressure was normal in the office but high at home, older adults had a 70% higher rate of falls than those whose blood pressure was high both in the office and at home. This deserves a closer look because falls can often accelerate decline in both physical and mental function."
The implications are significant for clinical practice. Home blood pressure monitoring, now more accessible, can reveal masked hypertension and identify older adults at hidden risk of falls. As the population ages, integrating home readings into routine care could help prevent falls and preserve independence. The American Heart Association provides resources such as Health Threats from High Blood Pressure and Understanding Blood Pressure Readings to help patients and caregivers manage blood pressure effectively. Additional tools are available through Find High Blood Pressure Tools and Resources. For more information on the association's financial policies, visit here.
