Prevalence of Masked Hypertension among Healthcare Workers: A Systematic Review and Meta-analysis of Ambulatory Blood Pressure Monitoring Studies

Abstract

Context: Healthcare workers experience shift work, sleep disruption and occupational stress, yet the burden of masked hypertension—normal office blood pressure with elevated out-of-office blood pressure—has not been synthesised. Objective: To estimate the prevalence of masked hypertension among healthcare workers and examine sources of variation. Evidence Acquisition: PubMed/MEDLINE and Europe PMC were searched from inception to 27 August 2026, supplemented by citation and targeted journal searching. Studies were eligible when healthcare personnel underwent paired office and ambulatory or home blood pressure measurement and reported a masked-hypertension numerator and denominator. Study quality was appraised using the JBI prevalence checklist. Proportions were pooled on the logit scale using a restricted maximum-likelihood random-effects model with Hartung–Knapp confidence intervals. Results: Six studies from Spain, the United States, Brazil and India included 1,325 participants and 244 masked-hypertension cases. Study estimates ranged from 8.7 to 23.9 per cent. Pooled prevalence was 17.1 per cent (95% confidence interval 11.3–25.1; I²=83.4%), with a 95% prediction interval of 5.5–42.4 per cent. Restriction to full 24-hour monitoring yielded 16.7 per cent (9.6–27.4). Shift work was associated with masked hypertension in two studies. Risk of bias was low-to-moderate in one study and moderate-to-high in five. Conclusions: Masked hypertension may affect about one in six healthcare workers in the available study samples. The estimate is not globally representative; heterogeneous definitions, selected samples and sparse regional coverage support targeted out-of-office confirmation rather than universal ambulatory screening.