For adults older than 78, masked hypertension—normal blood pressure readings in a doctor's office but elevated readings at home—is associated with a 70% higher risk of falls compared to sustained hypertension, according to preliminary research presented at the American Heart Association's Hypertension Scientific Sessions 2026. The findings, which also show that white coat hypertension carries a lower fall risk, underscore the critical need to incorporate home blood pressure monitoring into routine care for older adults.
Falls are the leading cause of disability and functional decline in adults age 65 and older, according to the U.S. Centers for Disease Control and Prevention. While low blood pressure is traditionally considered a fall risk factor, emerging evidence suggests that high home blood pressure may also contribute to falls. This study provides a fresh perspective by comparing different patterns of hypertension and their association with falls.
The study analyzed 758 adults aged 78-98 from the Atherosclerosis Risk in Communities (ARIC) study. Among them, 34.5% had sustained high blood pressure, 17.0% had white coat hypertension, 15.4% had masked hypertension, and 33.2% had normal readings. Over a median follow-up of 350 days, 23.4% reported falling at least once in the previous 12 months. When office and home blood pressure differences were analyzed continuously, lower office blood pressure relative to home blood pressure was linked to a higher incidence of falls.
"Preventing falls in elderly adults should be a top priority," said Frances Wang, Ph.D., M.S., the study's presenting author and a researcher at Beth Israel Deaconess Medical Center in Boston. "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." Wang emphasized that home monitoring can empower older adults and their caregivers to measure blood pressure regularly and share data with their healthcare team.
The results align with the American Heart Association's 2025 Joint Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, which recommends annual blood pressure monitoring and home monitoring to confirm diagnoses and tailor care. Karol E. Watson, M.D., Ph.D., FAHA, a volunteer expert for the American Heart Association who was not involved in the study, noted, "These findings confirm that 'normal' office blood pressure isn't always the end of the story. In this study, when blood pressure was normal in the office but high at home, older adults had a 70% higher rate of falls than those whose blood pressure was high both in the office and at home." Watson added that the study doesn't explain why fall risk was higher but may point to blood pressure variability and impaired regulation throughout the day.
The implications for clinical practice are significant. With home blood pressure monitoring becoming more accessible, healthcare professionals can use both office and home readings to identify hidden risks and prevent falls. The study's findings suggest that home monitoring can guide treatment decisions and potentially reduce fall-related disability and loss of independence. As the population of adults over 78 grows, integrating home blood pressure data into care plans could become a standard approach to fall prevention.
Additional resources from the American Heart Association include information on Health Threats from High Blood Pressure and Understanding Blood Pressure Readings. The abstracts will be published in the Hypertension Scientific Sessions 2026 Supplement of the Hypertension journal. The study was funded by the American Heart Association and the National Institutes of Health. As preliminary research, the findings are considered until published as a full manuscript in a peer-reviewed journal.
