Masked high blood pressure raises fall risk in seniors

A clean bill of health at the doctor's office may not mean blood pressure is fine. Preliminary research presented at the American Heart Association's Hypertension Scientific Sessions 2026 found that Masked high blood pressure, which looks normal during a clinic visit but runs high at home, was associated with a sharply higher rate of falls among adults in their late seventies and beyond. The pattern is easy to miss because a patient who hears good news at the clinic has little reason to keep checking at home.

Masked hypertension is the mirror image of the better-known white coat effect. With white coat hypertension, readings spike at the clinic and settle at home. With Masked high blood pressure, the clinic reading is the calm one, while home measurements tell a different story, according to an AHA news release about the findings. The presenting author was Frances Wang, Ph.D., M.S., a researcher at Beth Israel Deaconess Medical Center in Boston. The distinction matters because treatment decisions usually follow the office number, which in these cases was the misleading one.

How the study was run

The research drew on more than 750 adults between the ages of 78 and 98 who took part in the Atherosclerosis Risk in Communities study, a long-running federally funded project on heart disease risk factors. This analysis focused on the project's oldest age band. Every participant had blood pressure measured both in a clinic and at home with a home monitor, with the two sets of readings taken during the same period for a direct comparison. Most participants were women, and more than four in five were already taking medication to lower their blood pressure.

Sorting the participants by where their readings ran high produced four groups: 34.5% had sustained high blood pressure in both settings, 15.4% had Masked high blood pressure, 17% had white coat hypertension, and 33.2% had normal readings. After a median follow-up of 350 days, nearly one in four participants had fallen at least once in the previous year.

The surprise in the numbers

Compared with peers who had high readings in both settings, seniors with Masked high blood pressure had a 70% higher rate of falls. The white coat group went the other way, with a 39% lower risk of falls. Low blood pressure is usually the fall risk doctors watch for, yet the researchers pointed to emerging evidence that high home blood pressure can raise the chance of a fall as well. The AHA notes that shifts in blood pressure can lead to dizziness or fainting, which is how a fall begins. Watson added that swings in blood pressure between settings may also play a role, an idea the research team says needs more study.

The stakes are high because 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. The results line up with the AHA's 2025 guideline for managing high blood pressure, which calls for yearly monitoring for all adults and recommends home readings to confirm a diagnosis made in the office. Karol E. Watson, MD, PhD, an AHA volunteer expert, said a normal office reading does not always tell the full story, and she noted that a fall can accelerate a decline in both physical and mental function once independence is lost.

What to do with this information

For families, the practical thread is home monitoring. Regular readings at home can reveal the hidden pattern, and the researchers say those numbers are worth sharing with a doctor or care team. Home monitoring already pulls double duty: it is the recommended way to confirm an office diagnosis and tailor care, and now it may flag a fall risk that the office visit misses. Preventing falls in older adults should be a top priority, Wang said in the AHA release. The findings are preliminary: abstracts presented at AHA scientific meetings are not peer-reviewed, so the link between Masked high blood pressure and falls deserves a closer look before anyone treats it as settled.

The study was funded by the American Heart Association and the National Institutes of Health.