The influence of masked hypertension on the right ventricle: is everything really masked?

• Right ventricular wall thickness is increased in masked hypertension.
• Right ventricular diastolic function is deteriorated in subjects with masked hypertension.
• Right ventricular longitudinal strain is significantly lower in masked hypertension.
• Right ventricular mechanics during the whole cardiac cycle is deteriorated in masked hypertension.
• Subendocardial and midmyocardial right ventricular longitudinal layer strains are reduced in masked hypertension.

We sought to investigate right ventricular (RV) structure, function, and mechanics in subjects with masked hypertension (MH), normotensive, and sustained hypertensive patients. This cross-sectional study included 186 untreated subjects who underwent 24-hour ambulatory blood pressure (BP) monitoring and complete two-dimensional echocardiographic (2DE) examination including multilayer strain analysis. MH was diagnosed if clinic BP was normal (<140/90 mm Hg) and 24-hour BP was increased (≥130/80 mm Hg). Global and free-wall RV longitudinal strains were significantly lower in MH and sustained hypertensive patients comparing with controls. Systolic and early diastolic RV strain rates were lower, whereas late diastolic strain rate was higher, among patients with MH and sustained hypertension than in control group. Endocardial and midmyocardial RV strains were also significantly lower in MH and hypertensive patients. There was no difference between MH and subjects with sustained hypertension. RV structure, function, and deformation are significantly changed in subjects with MH and sustained hypertension.