Elderly Adults With Masked High Blood Pressure Linked To Higher Risk Of Falls

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A preliminary study of 758 adults older than 78 found that participants with masked high blood pressure—normal readings in a medical office but high readings at home—had a 70% higher rate of falls than those with high readings in both settings. The findings were presented at the American Heart Association’s 2026 Hypertension Scientific Sessions; they show an association, not that masked hypertension causes falls.

Adults older than 78 whose blood pressure was normal in a medical office but high at home had a 70% higher rate of falls than peers with high readings in both settings, according to preliminary research presented at the American Heart Association’s Hypertension Scientific Sessions in Arlington, Virginia. The finding suggests home measurements may reveal elevated blood pressure that an office reading misses, although the study does not establish that the condition causes falls.

The study included 758 adults older than 78, grouped according to blood pressure readings taken in medical and home settings. Researchers classified 15.4% as having masked high blood pressure, meaning their office readings were not high while their home readings were. Another 34.5% had sustained high blood pressure, with elevated readings in both settings; 17.0% had white coat high blood pressure; and 33.2% had normal readings in both settings.

Over a median follow-up of 350 days, 23.4% of participants reported having fallen at least once in the previous 12 months. The reported 70% difference compares the fall rate for participants with masked high blood pressure with the rate for those whose readings were high in both places. It is a relative comparison between these study groups, not a measure of an individual’s likelihood of falling, and the report does not provide the groups’ absolute fall rates.

The researchers also found that, when office and home readings were examined as a continuous difference, lower office pressure relative to home pressure was associated with a higher incidence of falls. The results were preliminary research presented at a scientific meeting, rather than a finding that by itself establishes a cause or changes clinical guidelines.

Why Home Readings May Matter

Blood pressure checks are often taken during clinic visits, but a single office measurement may not reflect readings at home. In this study, the difference between those settings helped identify a group with an elevated fall rate despite office readings that did not show high blood pressure. That makes the finding relevant to older adults and care teams considering how to assess blood pressure alongside other fall-risk factors.

Falls can have serious consequences for older people. The U.S. Centers for Disease Control and Prevention identifies falls as the leading cause of disability and functional decline among adults 65 and older. American Heart Association volunteer expert Karol E. Watson said falls can accelerate losses in physical and mental function, while cautioning that this study does not explain why the association appeared.

The result should not be read as proof that lowering home blood pressure will prevent falls, or as a reason for patients to change medication without medical guidance. It points instead to a possible benefit of sharing home readings with a health professional, who can interpret them with a person’s health history and care plan.

Office Readings and Hidden Hypertension

Masked high blood pressure describes a pattern in which readings are not high in a clinical setting but are elevated outside it, such as at home. The opposite pattern is commonly called white coat high blood pressure: readings are high in the medical office but not at home. The study compared these patterns with sustained high blood pressure and normal readings in both settings.

The American Heart Association’s 2025 joint guideline recommends annual blood pressure monitoring for all adults. It recommends home monitoring to help confirm an office diagnosis of high blood pressure and to track readings and inform care as part of an integrated plan. The guideline is broader than this study: the conference findings do not themselves constitute a new recommendation specific to fall prevention.

Study presenting author Frances Wang, a researcher at Beth Israel Deaconess Medical Center in Boston, said home measurements can add information to office checks. The research was presented during the association’s Hypertension Scientific Sessions, held Oct. 7–11, 2026.

“These findings highlight that, in addition to office blood pressure measurement, home blood pressure readings can be an important way to identify hidden high blood pressure at home and risk of falls in older adults.”

— Frances Wang, Ph.D., M.S., study presenting author and researcher at Beth Israel Deaconess Medical Center

What the Study Cannot Establish

The findings show an association, not proof of cause and effect. Researchers and the expert quoted in the report said the analysis does not explain why falls were more frequent in the masked-high-pressure group. Blood pressure variability or differences in how people regulate pressure during the day were raised as possibilities, not confirmed explanations.

The report describes falls as self-reported and gives the overall proportion of participants who reported at least one fall, but it does not provide the absolute fall rates for each blood pressure group. It also does not establish whether the association would be similar in younger people, adults living in different settings, or a broader population. The follow-up was a median of 350 days, and the reported study is preliminary.

It is also unclear from the report whether treating masked high blood pressure would reduce falls, or which measurement schedule and care response would best address the pattern. The results do not show that every older adult with a normal office reading has high blood pressure at home.

Home Monitoring in Clinical Care

The study’s findings were presented at the 2026 Hypertension Scientific Sessions. The supplied report does not describe a planned trial or give a timeline for additional results, so it is not clear when further evidence about causes or prevention may become available.

For now, the American Heart Association guideline supports home blood pressure monitoring as a way to help confirm a diagnosis and track readings within a care plan. Wang encouraged older adults and caregivers to share home measurements with a health care team. Decisions about interpreting readings or adjusting treatment should be made with a qualified health professional; the study does not offer a specific fall-prevention treatment.

Key Questions

What does masked high blood pressure mean?

It means blood pressure readings are not high in a medical office but are high at home. Comparing measurements from both settings can reveal a pattern that an office reading alone may miss.

How much higher was the fall rate in the study?

Among adults older than 78, the group with masked high blood pressure had a 70% higher fall rate than the group with high readings both in the office and at home. The report does not give the absolute fall rate for each group, so the comparison does not tell readers an individual’s specific risk.

Does the study show that masked high blood pressure causes falls?

No. It found an association, but did not establish that masked high blood pressure caused the falls. The reason for the higher rate is not known; blood pressure variability was suggested as a possibility, not demonstrated as an explanation.

Should older adults change their blood pressure treatment because of this report?

The report does not recommend changing treatment. Home readings can be shared with a qualified health professional, who can interpret them as part of an individual care plan. Medication decisions should be discussed with that professional.

Source: rss