MASKED ARTERIAL HYPERTENSION IN PRE-EMPLOYMENT EXAMINATIONS: DIAGNOSTIC CHALLENGES AND IMPLICATIONS FOR OCCUPATIONAL HEALTH

Abstract

Masked hypertension represents a significant diagnostic challenge, characterized by the presence of normal blood pressure levels in a clinical setting and elevated blood pressure outside the doctor's office, often undetected in conventional assessments. In the context of occupational health, this condition may remain underdiagnosed during pre-employment medical examinations, especially in workers exposed to occupational factors related to increased cardiovascular risk. This study aimed to analyze the available scientific evidence regarding masked hypertension in pre-employment medical examinations, its diagnostic challenges, and its implications for occupational health. An integrative literature review was conducted in the PubMed/MEDLINE, LILACS, SciELO, and Google Scholar databases, including studies on masked hypertension, ambulatory blood pressure monitoring (ABPM), home blood pressure monitoring (HBPM), occupational health, and cardiovascular risk. The analyzed studies demonstrated an association between masked hypertension and factors such as occupational stress, prolonged work hours, and high psychosocial demands, in addition to highlighting limitations of conventional blood pressure measurement in a clinical setting. MAPA and MRPA proved to be relevant tools for the early identification of this hypertensive phenotype, allowing for greater diagnostic accuracy. Furthermore, masked hypertension was associated with a higher risk of target organ damage, progression to sustained hypertension, and adverse cardiovascular events. It is concluded that masked hypertension is a potentially underdiagnosed condition in pre-employment examinations, reinforcing the need for more comprehensive diagnostic strategies in the occupational context, especially in workers with greater exposure to cardiovascular risk factors.