Hidden high blood pressure at home linked to more falls in older adults

Clinical takeaway: Consider home blood pressure monitoring in older adults, even when office readings appear controlled. Elevated blood pressure at home may identify patients at increased risk of falls that would otherwise go unnoticed.

Falls are a leading cause of disability and loss of independence in older adults, yet blood pressure assessments are often based primarily on office measurements. These preliminary findings suggest that comparing home and clinic blood pressure readings may provide additional insight into fall risk among very elderly patients.

Among adults aged 78 to 98 years, masked hypertension, defined as normal office blood pressure but elevated readings at home, was associated with a 70% higher risk of falls compared with sustained hypertension, according to research presented at the American Heart Association Hypertension Scientific Sessions 2026. Because the findings come from a meeting abstract, they have not yet been peer reviewed.

Researchers analyzed 758 participants in the community-based ARIC cohort. Median age was 83 years, 59% were women, and 82% were taking antihypertensive medication. Participants underwent standardized office blood pressure measurements and completed morning and evening home blood pressure monitoring over eight nonconsecutive days.

Overall, 15.4% of participants had masked hypertension, 17.0% had white-coat hypertension, 34.5% had sustained hypertension, and 33.2% had normal blood pressure in both settings. During a median follow-up of about one year, nearly one in four participants reported at least one fall.

Investigators also found that lower office blood pressure relative to home blood pressure was associated with a greater incidence of falls. In contrast, white-coat hypertension, in which office readings are elevated but home readings are lower, was linked to a lower fall risk than sustained hypertension.

"These findings highlight that, in addition to office blood pressure measurement, home blood pressure readings can be an important way to identify hidden home high blood pressure and risk of falls in older adults," said presenting author Frances Wang, PhD, MS, of Beth Israel Deaconess Medical Center.

Source: Wang F, et al. (2026 Oct 9) American Heart Association Hypertension Scientific Sessions 2026. Oral Presentation #38. Masked high blood pressure and fall risk in older adults