Persistence and progression of masked hypertension: a 5-year prospective study

Masked phenomenon: renal and cardiovascular complications; review and updates

BACKGROUND

In the in-clinic blood pressure (BP) recording setting, a sizable number of individuals with normal BP and approximately 30% of patients with chronic renal disease (CKD) exhibit elevated outpatient BP records. These individuals are known as masked hypertension (MHTN), and when they are on antihypertensive medications, but their BP is not controlled, they are called masked uncontrolled hypertension (MUHTN). The masked phenomenon (MP) (MHTN and MUHTN) increases susceptibility to end-organ damage (a two-fold greater risk for cardiovascular events and kidney dysfunction). The potential extension of the observed benefits of MP therapy, including a reduction in end-organ damage, remains questionable.

AIM AND METHODS

This review aims to study the diagnostic methodology, epidemiology, pathophysiology, and significance of MP management in end-organs, especially the kidneys, cardiovascular system, and outcomes. To achieve the purposes of this non-systematic comprehensive review, PubMed, Google, and Google Scholar were searched using keywords, texts, and phrases such as masked phenomenon, CKD and HTN, HTN types, HTN definition, CKD progression, masked HTN, MHTN, masked uncontrolled HTN, CKD onset, and cardiovascular system and MHTN. We restricted the search process to the last ten years to search for the latest updates.

CONCLUSION

MHTN is a variant of HTN that can be missed if medical professionals are unaware of it. Early detection by ambulatory or home BP recording in susceptible individuals reduces end-organ damage and progresses to sustained HTN. Adherence to the available recommendations when dealing with masked phenomena is justifiable; however, further studies and recommendation updates are required.

Efficacy of antihypertensive treatment for target organ protection in patients with masked hypertension (ANTI-MASK): a multicentre, double-blind, placebo-controlled trial

Background

Masked hypertension is associated with target organ damage (TOD) and adverse health outcomes, but whether antihypertensive treatment improves TOD in patients with masked hypertension is unproven.

Methods

In this multicentre, randomised, double-blind, placebo-controlled trial at 15 Chinese hospitals, untreated outpatients aged 30-70 years with an office blood pressure (BP) of <140/<90 mm Hg and 24-h, daytime or nighttime ambulatory BP of ≥130/≥80, ≥135/≥85, or ≥120/≥70 mm Hg were enrolled. Patients had ≥1 sign of TOD: electrocardiographic left ventricular hypertrophy (LVH), brachial-ankle pulse wave velocity (baPWV) ≥1400 cm/s, or urinary albumin-to-creatinine ratio (ACR) ≥3.5 mg/mmol in women and ≥2.5 mg/mmol in men. Exclusion criteria included secondary hypertension, diabetic nephropathy, serum creatinine ≥176.8 μmol/L, and cardiovascular disease within 6 months of screening. After stratification for centre, sex and the presence of nighttime hypertension, eligible patients were randomly assigned (1:1) to receive antihypertensive treatment or placebo. Patients and investigators were masked to group assignment. Active treatment consisted of allisartan starting at 80 mg/day, to be increased to 160 mg/day at month 2, and to be combined with amlodipine 2.5 mg/day at month 4, if the ambulatory BP remained uncontrolled. Matching placebos were used likewise in the control group. The primary endpoint was the improvement of TOD, defined as normalisation of baPWV, ACR or LVH or a ≥20% reduction in baPWV or ACR over the 48-week follow-up. The intention-to-treat analysis included all randomised patients, the per-protocol analysis patients who fully adhered to the protocol, and the safety analysis all patients who received at least one dose of the study medication. This study is registered with ClinicalTrials.gov, NCT02893358.

Findings

Between February 14, 2017, and October 31, 2020, 320 patients (43.1% women; mean age ± SD 53.7 ± 9.7 years) were enrolled. Baseline office and 24-h BP averaged 130 ± 6.0/81 ± 5.9 mm Hg and 136 ± 8.6/84 ± 6.1 mm Hg, and the prevalence of elevated baPWV, ACR and LVH were 97.5%, 12.5%, and 7.8%, respectively. The 24-h BP decreased on average (±SE) by 10.1 ± 0.9/6.4 ± 0.5 mm Hg in 153 patients on active treatment and by 1.3 ± 0.9/1.0 ± 0.5 mm Hg in 167 patients on placebo. Improvement of TOD occurred in 79 patients randomised to active treatment and in 49 patients on placebo: 51.6% (95% CI 43.7%, 59.5%) versus 29.3% (22.1, 36.5%; p < 0.0001). Per-protocol and subgroup analyses were confirmatory. Adverse events were generally mild and occurred in 38 (25.3%) and 43 (26.4%) patients randomised to active treatment and placebo, respectively (p = 0.83).

Interpretation

Our results suggest that antihypertensive treatment improves TOD in patients with masked hypertension, highlighting the need of treatment. However, the long-term benefit in preventing cardiovascular complications still needs to be established.

Funding

Salubris China.

Isolated Nocturnal Hypertension in Children

Isolated nocturnal hypertension (INH) is attracting attention because it has been shown to correlate with target organ damage as well as cardiovascular events in adults. INH has also been reported in children especially in those with underlying diseases including chronic kidney disease and some studies reported association with markers of early target organ damage. INH occupies the majority of nocturnal hypertension. On the other hand, masked hypertension is largely attributed to INH. INH is usually diagnosed by ambulatory blood pressure monitoring. Recently, it became possible to monitor sleep blood pressure by an automated home blood pressure device feasible also in children. The epidemiology, methodology and reproducibility, pathophysiology, relation to target organ damage, and treatment of INH in children will be reviewed here along with adult data.

Contribution of single office aortic systolic blood pressure measurements to the detection of masked hypertension: data from two separate cohorts

Masked hypertension (MH) and masked uncontrolled hypertension (MUH) remain largely underdiagnosed with no efficient detection algorithm. We recently proposed a novel classification of office systolic hypertension phenotypes defined on the basis of both brachial and aortic systolic blood pressure (bSBP/aSBP) and showed that type III ("isolated high office aSBP" phenotype: normal office bSBP but high office aSBP) has higher hypertension-mediated organ damage (HMOD). We tested whether MH/MUH (1) can be detected with the "isolated high office aSBP" phenotype and (2) if it is associated with elevated office aSBP with respect to normotension. We classified two separate and quite different cohorts (n = 391 and 956, respectively) on the basis of both bSBP and aSBP into four different phenotypes. Participants were classified as sustained hypertensives, masked hypertensives/masked uncontrolled hypertensives (MHs/MUHs), white coat hypertensives, and normotensives according to their office and out-of-office BP readings. The majority (more than 60% in cohort A and more than 50% in cohort B) of type III individuals were MHs/MUHs. Almost 35% of MHs/MUHs had optimal office bSBP rather than high normal bSBP. In both cohorts, the detection of more than 40% of MH/MUH was feasible with the type III phenotype. MHs/MUHs had higher office aSBP than individuals with sustained normotension (p < 0.05). In conclusion, in the absence of an efficient screening test, the diagnosis of MH/MUH can be assisted by the detection of the "isolated high office aSBP" phenotype, which can be measured in a single office visit. MHs/MUHs have increased aSBP relative to normotensives, further explaining the increased mortality of MH/MUH.

Long Working Hours and the Prevalence of Masked and Sustained Hypertension

Previous studies on the effect of long working hours on blood pressure have shown inconsistent results. Mixed findings could be attributable to limitations related to blood pressure measurement and the lack of consideration of masked hypertension. The objective was to determine whether individuals who work long hours have a higher prevalence of masked and sustained hypertension. Data were collected at 3-time points over 5 years from 3547 white-collar workers. Long working hours were self-reported, and blood pressure was measured using Spacelabs 90207. Workplace clinic blood pressure was defined as the mean of the first 3readings taken at rest at the workplace. Ambulatory blood pressure was defined as the mean of the next readings recorded every 15 minutes during daytime working hours. Masked hypertension was defined as clinic blood pressure < 140/90 mm Hg and ambulatory blood pressure ≥135/85 mm Hg. Sustained hypertension was defined as clinic blood pressure ≥140/90 mm Hg and ambulatory blood pressure ≥135/85 mm Hg or being treated hypertension. Long working hours were associated with the prevalence of masked hypertension (prevalence ratio 49+ =1.70 [95% CI, 1.09–2.64]), after adjustment for sociodemographics, lifestyle-related risk factors, diabetes mellitus, family history of cardiovascular disease, and job strain. The association with sustained hypertension was of a comparable magnitude (prevalence ratio 49+ =1.66 [95% CI, 1.15–2.50]). Results suggest that long working hours are an independent risk factor for masked and sustained hypertension. Workplace strategies targeting long working hours could be effective in reducing the clinical and public health burden of hypertension.

Blood Pressure Measurement and Treatment Decisions

White-coat and masked hypertension are important hypertension phenotypes. Out-of-office blood pressure measurement is essential for the accurate diagnosis and monitoring of these conditions. This review summarizes literature related to the detection and diagnosis, prevalence, epidemiology, prognosis, and treatment of white-coat and masked hypertension. Cardiovascular risk in white-coat hypertension appears to be dependent on the presence of coexisting risk factors, whereas patients with masked hypertension are at increased risk of target organ damage and cardiovascular events. There is an unmet need for robust data to support recommendations around the use of antihypertensive treatment for the management of white-coat and masked hypertension.

Reproducibility of masked uncontrolled hypertension detected through home blood pressure monitoring

Masked uncontrolled hypertension (MUCH) is an entity described in treated hypertensive subjects, where office blood pressure (BP) is well controlled and out-of-office BP is elevated. It has been related to a higher cardiovascular risk. However, the reproducibility of MUCH has been scarcely studied. In this study, we aimed to determine the reproducibility of MUCH detected through home blood pressure monitoring (HBPM). Two sets of measurements were performed in hypertensive adults under stable treatment with a 1-week interval. Each set of measurements included three office BP readings and a 4-day HBPM with duplicate readings in the morning, afternoon, and evening (the same validated oscillometric device was employed in both settings). We determined the percentage of agreement regarding the presence of MUCH in the two sets of measurements and quantified such agreement through the Cohen's kappa coefficient (κ), its 95% confidence interval, and P value. We included 105 patients (median age 58.6 [IQR 45.6-67.2] years old, 53.4% men). MUCH prevalence on at least one occasion was 22.3% (95% CI: 15.2-31.5). The reproducibility of MUCH was scant: κ = 0.19 (95% CI: 0.0002-0.38), P = 0.02, due to the poor reproducibility of the office BP component of MUCH in comparison with the home BP component: κ = 0.21 (95% CI: 0.03-0.39), P = 0.01 vs κ = 0.48 (95% CI 0.29-0.67), P < 0.001, respectively. In conclusion, the reproducibility of MUCH detected through HBPM is minimal, mainly due to the poor reproducibility of office BP measurements. An HBPM-based strategy for the management of patients with MUCH may be more adequate in terms of cardiovascular morbidity and mortality.

When Office Blood Pressure Is Not Enough: The Case of Masked Hypertension

An increasing attention has been devoted in the last two decades to masked hypertension (MH), a condition characterized by the fact that classification of a normal blood pressure (BP) status by office measurements is not confirmed by home and/or ambulatory BP monitoring (ABPM). MH definition (i.e., normal office BP, but high out-of-office BP) should be restricted to untreated subjects (true MH) whereas masked uncontrolled hypertension (MUCH) reserved to treated patients previously classified as hypertensives, presenting normal office BP and high ABPM or home values. Both MH and MUCH are associated with metabolic alterations, comorbidities, and hypertension-mediated organ damage (HMOD). Furthermore, the risk of cardiovascular events related to these conditions has been shown to be close or greater than that of sustained hypertension. This review discusses available evidence about MH and MUCH by focusing on its prevalence, clinical correlates, association with HMOD, prognostic significance, and their therapeutic implications.

Psychosocial Stressors at Work and Ambulatory Blood Pressure

PURPOSE OF REVIEW

Psychosocial stressors at work from the demand-latitude and effort-reward imbalance models are adverse exposures affecting about 20-25% of workers in industrialized countries. This review aims to summarize evidence on the effect of these stressors on blood pressure (BP).

RECENT FINDINGS

Three systematic reviews have recently documented the effect of these psychosocial stressors at work on BP. Among exposed workers, statistically significant BP increases ranging from 1.5 to 11 mmHg have been observed in prospective studies using ambulatory BP (ABP). Recent studies using ABP have shown a deleterious effect of these psychosocial stressors at work on masked hypertension as well as on blood pressure control in pharmacologically treated patients. Evidence on the effect of these psychosocial stressors on BP supports the relevance to tackle these upstream factors for primary prevention and to reduce the burden of poor BP control. There is a need for increased public health and clinical awareness of the occupational etiology of high BP, hypertension, and poor BP control.

Masked hypertension and cardiovascular outcomes: an updated systematic review and meta-analysis

Background

As many as one-third of individuals with normal office blood pressure (BP) are diagnosed with masked hypertension (HTN) based on ambulatory BP measurements (ABPM). Masked HTN is associated with higher risk of sustained HTN (SH) and increased cardiovascular morbidity.

Methods

The present study was designed to systematically review cohort studies and assess the effects of masked HTN compared to normotension and SH on cardiovascular events and all-cause mortality. We systematically searched the electronic databases, such as MEDLINE, PubMed, Embase, and Cochrane for prospective cohort studies, which evaluated participants with office and ambulatory and/or home BP.

Results

We included nine studies with a total number of 14729 participants (11245 normotensives, 3484 participants with masked HTN, 1984 participants with white-coat HTN, and 5143 participants with SH) with a mean age of 58 years and follow-up of 9.5 years. Individuals with masked HTN had significantly increased rates of cardiovascular events and all-cause mortality than normotensives and white-coat HTN and had lower rates of cardiovascular events than those with SH (odds ratio 0.61, 95% confidence interval 0.42–0.89; P=0.010; I²=84%). Among patients on antihypertensive treatment, masked HTN was associated with higher rates of cardiovascular events than in those with normotension and white-coat HTN and similar rates of cardiovascular events in those with treated SH.

Conclusion

Prompt screening of high-risk individuals with home BP measurements and ABPM, the diagnosis of masked HTN, and the initiation of treatment, may mitigate the adverse cardiovascular effects of masked HTN.

Predicting Out-of-Office Blood Pressure in the Clinic for the Diagnosis of Hypertension in Primary Care: An Economic Evaluation

Clinical guidelines in the United States and United Kingdom recommend that individuals with suspected hypertension should have ambulatory blood pressure (BP) monitoring to confirm the diagnosis. This approach reduces misdiagnosis because of white coat hypertension but will not identify people with masked hypertension who may benefit from treatment. The Predicting Out-of-Office Blood Pressure (PROOF-BP) algorithm predicts masked and white coat hypertension based on patient characteristics and clinic BP, improving the accuracy of diagnosis while limiting subsequent ambulatory BP monitoring. This study assessed the cost-effectiveness of using this tool in diagnosing hypertension in primary care. A Markov cost-utility cohort model was developed to compare diagnostic strategies: the PROOF-BP approach, including those with clinic BP ≥130/80 mm Hg who receive ambulatory BP monitoring as guided by the algorithm, compared with current standard diagnostic strategies including those with clinic BP ≥140/90 mm Hg combined with further monitoring (ambulatory BP monitoring as reference, clinic, and home monitoring also assessed). The model adopted a lifetime horizon with a 3-month time cycle, taking a UK Health Service/Personal Social Services perspective. The PROOF-BP algorithm was cost-effective in screening all patients with clinic BP ≥130/80 mm Hg compared with current strategies that only screen those with clinic BP ≥140/90 mm Hg, provided healthcare providers were willing to pay up to £20 000 ($26 000)/quality-adjusted life year gained. Deterministic and probabilistic sensitivity analyses supported the base-case findings. The PROOF-BP algorithm seems to be cost-effective compared with the conventional BP diagnostic options in primary care. Its use in clinical practice is likely to lead to reduced cardiovascular disease, death, and disability.

Masked hypertension: understanding its complexity

Masked hypertension, which is present when in-office normotension translates to out-of-office hypertension, is present in a surprisingly high percentage of untreated persons and an even higher percentage of patients after beginning antihypertensive medication. Not only are persons with prehypertension more likely to have masked hypertension than those with optimal blood pressure (BP), but also they frequently develop target organ damage prior to transitioning to sustained hypertension. Furthermore, the frequency of masked hypertension is high in individuals of African inheritance and in the presence of increased cardiovascular risk factors and disease states, such as diabetes and chronic renal failure. Nocturnal hypertension and non-dipping may be early markers of masked hypertension. Twenty-four hour ambulatory BP monitoring (ABPM), which can detect nighttime and 24 h elevated BP, remains the gold standard for diagnosing masked hypertension. Almost one-third of treated patients with masked hypertension remain as 'masked uncontrolled hypertension', and it becomes important, therefore, to use ABPM (and supplemental home BP monitoring) for the effective diagnosis and control of hypertension.

Masked hypertension and effort-reward imbalance at work among 2369 white-collar workers

Hypertension is an important risk factor of cardiovascular diseases, the leading cause of death worldwide. Adverse effects of psychosocial factors at work might increase the risk of masked hypertension, but evidences are still scarce. The objective of this study is then to determine whether adverse psychosocial work factors from the effort-reward imbalance (ERI) model are associated with the prevalence of masked hypertension in a population of white-collar workers. White-collar workers were recruited from three public organizations. Blood pressure was measured at the workplace for manually operated measurements (mean of the first three readings taken by a trained assistant) followed by ambulatory measurements (mean of all subsequent readings taken during the working day). Masked hypertension was defined as manually operated BP<140/90 mm Hg and ambulatory BP ⩾135/85 mm Hg. ERI exposure at work was measured using Siegrist's validated questionnaire. Blood pressure readings were obtained from 2369 workers (participation proportion: 85%). ERI exposure (OR: 1.53 (95% CI: 1.16-2.02) and high efforts at work (OR: 1.61 (95% CI: 1.13-1.29) were associated with masked hypertension, after adjusting for sociodemographic and cardiovascular risk factors. Workers exposed to an imbalance between efforts spent at work and reward had a higher prevalence of masked hypertension. High efforts at work might be of particular importance in explaining this association. Future studies should be designed to investigate how clinicians can include questions on psychosocial work factors to screen for masked hypertension and how workplace interventions can decrease adverse psychosocial exposures to lower BP.

Masked Hypertension and Incident Clinic Hypertension Among Blacks in the Jackson Heart Study

Masked hypertension, defined as nonelevated clinic blood pressure (BP) and elevated out-of-clinic BP may be an intermediary stage in the progression from normotension to hypertension. We examined the associations of out-of-clinic BP and masked hypertension using ambulatory BP monitoring with incident clinic hypertension in the Jackson Heart Study, a prospective cohort of blacks. Analyses included 317 participants with clinic BP <140/90 mm Hg, complete ambulatory BP monitoring, who were not taking antihypertensive medication at baseline in 2000 to 2004. Masked daytime hypertension was defined as mean daytime blood pressure ≥135/85 mm Hg, masked night-time hypertension as mean night-time BP ≥120/70 mm Hg, and masked 24-hour hypertension as mean 24-hour BP ≥130/80 mm Hg. Incident clinic hypertension, assessed at study visits in 2005 to 2008 and 2009 to 2012, was defined as the first visit with clinic systolic/diastolic BP ≥140/90 mm Hg or antihypertensive medication use. During a median follow-up of 8.1 years, there were 187 (59.0%) incident cases of clinic hypertension. Clinic hypertension developed in 79.2% and 42.2% of participants with and without any masked hypertension, 85.7% and 50.4% with and without masked daytime hypertension, 79.9% and 43.7% with and without masked night-time hypertension, and 85.7% and 48.2% with and without masked 24-hour hypertension, respectively. Multivariable-adjusted hazard ratios (95% confidence interval) of incident clinic hypertension for any masked hypertension and masked daytime, night-time, and 24-hour hypertension were 2.13 (1.51-3.02), 1.79 (1.24-2.60), 2.22 (1.58-3.12), and 1.91 (1.32-2.75), respectively. These findings suggest that ambulatory BP monitoring can identify blacks at increased risk for developing clinic hypertension.

Life events and chronic physical conditions among left-behind farmers in rural China a cross-sectional study

BACKGROUND

This study investigates the relationships between life events and chronic physical conditions among left behind farmers, a newly emerged weak group in vast rural China.

METHODS

The study collected information about life events, chronic physical conditions, blood pressure and fasting blood glucose from 4681 famers living in 18 randomly selected villages (Lu'an, Anhui, China) from early November 2013 to the end of December 2013. It compared the risk and odds ratios (RRs/ORs) among different subgroups divided according two life event indices derived by adding up un-weighted-ratings and weighted-ratings based on multivariate logistic regression coefficients respectively.

RESULTS

A total of 4040 (86.3 % eligible) farmers completed the survey. RRs between farmers with lower than the first 1/15-percentile of life event index and with higher life event index scores ranged 1.43-5.79 for chronic gastritis and 0.42-9.07 for prostatitis, 1.01-4.97 for cervicitis/vaginitis, 1.45-3.28 for cardio-cerebrovascular diseases, 1.12-1.58 for hypertension, 1.00-1.66 for diabetes, 1.07-3.35 for pre-diabetes and 5.00-55.00 for "other chronic physical conditions".

CONCLUSIONS

Life events were independently linked with most of the chronic physical conditions in a dose-effectiveness way. RRs between subgroups divided by given percentile cutoff points of life event index compiled using logistic regression models turned out to be substantially higher than that between subgroups divided by same cutoff points of life event index produced via summing up the un-weighted Likert ratings of all the events studied.

Ambulatory blood pressure phenotypes and the risk for hypertension

Ambulatory blood pressure (BP) monitoring provides valuable information on a person's BP phenotype. Abnormal ambulatory BP phenotypes include white-coat hypertension, masked hypertension, nocturnal nondipping, nocturnal hypertension, and high BP variability. Compared to people with sustained normotension (normal BP in the clinic and on ambulatory BP monitoring), the limited research available suggests that the risk of developing sustained hypertension (abnormal BP in the clinic and on ambulatory BP monitoring) over 5 to 10 years is approximately two to three times greater for people with white-coat or masked hypertension. More limited data suggest that nondipping might predate hypertension, and no studies, to our knowledge, have examined whether nocturnal hypertension or high ambulatory BP variability predict hypertension. Ambulatory BP monitoring may be useful in identifying people at increased risk of developing sustained hypertension, but the clinical utility for such use would need to be further examined.

Untreated masked hypertension and carotid atherosclerosis: a meta-analysis

AIM

Masked hypertension (MH) is recognized as a clinical entity with an unfavorable cardiovascular prognosis; a limited number of reports, however, investigated the impact of this condition on subclinical vascular damage. We performed a meta-analysis aimed at evaluating the association of MH with subclinical carotid atherosclerosis in initially untreated subjects.

DESIGN

Studies were identified by the following search terms: "masked hypertension", "isolated clinic normotension", "white coat normotension", "carotid artery", "carotid atherosclerosis", "carotid intima-media thickness", "carotid damage" and "carotid thickening". Full articles published in English language reporting data from studies performed in untreated adult individuals were considered.

RESULTS

Overall, 2752 untreated subjects (1039 normotensive, 497 MH and 766 hypertensive individuals) of both genders were included in five studies (sample size range 18-222 for MH participants). Common carotid intima-media thickness (IMT) showed a progressive increase from normotensive (681 ± 24 μm) to MH (763 ± 57 μm) (standardized mean difference, SMD: 0.51 ± 0.19, 95% CI 0.13-0.89, p < 0.01) and to sustained hypertensive subjects (787 ± 58 μm) (SMD: 0.33 ± 0.07, 95% CI 0.20-0.46, p < 0.01). The statistical difference between MH and NT became borderline after correction for publication bias. A sensitivity analysis showed that the final result was not substantially affected by a single study effect.

CONCLUSIONS

Our findings support the view that MH subjects tend to have a higher risk of developing early carotid atherosclerosis than their true normotensive counterparts. From a practical perspective, the ultrasound search of preclinical carotid disease may improve cardiovascular risk stratification and decision making strategies in these subjects.

Associations of blood pressure with common factors among left-behind farmers in rural China: a cross-sectional study using quantile regression analysis

The whole range of blood pressure (BP) has important implications. Yet, published studies focus primarily on hypertension and hypotension, the two extremes of BP continuum. This study aims at exploring quantile-specific associations of BP with common factors. The study used cross-sectional survey, collected information about gender, age, education, body mass index (BMI), alcohol intake, diet risk behavior, life event index, physical activity, fasting capillary glucose (FCG), and systolic/diastolic blood pressure (SBP/DBP) and pulse pressure (PP) from farmers living in 18 villages from rural Anhui, China, and performed descriptive and multivariate and quantile regression (QR) analysis of associations of SBP, DBP, or PP with the 9 factors surveyed. A total of 4040 (86.3%) eligible farmers completed the survey. Average hypertension prevalence rate and SBP, DBP, and PP values estimated 43.20 ± 0.50% and 141.37 ± 21.98, 87.76 ± 12.23, and 53.63 ± 15.72 mm Hg, respectively. Multivariate regression analysis revealed that all the 9 factors were significantly (P < 0.05) associated with one or more of SBP, DBP, and PP. QR coefficients of SBP, DBP, or PP with different factors demonstrated divergent patterns and age, BMI, FCG, and life event index showed substantial trends along the quantile axis. Hypertension prevalence rate was high among the farmers. QR modeling provided more detailed view on associations of SBP, DBP, or PP with different factors and uncovered apparent quantile-related patterns for part of the factors. Both the population group studied and the trends in QR coefficients identified merit specific attention.