Masked high blood pressure linked to higher risk of falls in older adults

Masked high blood pressure in adults older than age 78 is associated with a 70% higher risk of falls compared to high blood pressure readings in the office and at home among peers, according to preliminary research presented at the American Heart Association's Hypertension Scientific Sessions 2026. The meeting is in Arlington, Virginia, October 7-11, 2026, and is the premier scientific exchange focused on recent advances in basic and clinical research on high blood pressure and its relationship to cardiac and kidney disease, stroke, obesity and genetics.

Falls are the leading cause of disability and functional decline in adults age 65 years and older, according to the U.S. Centers for Disease Control and Prevention. Even though low blood pressure is usually thought of as a risk factor for falls, there is emerging evidence that high home blood pressure is associated with higher incidence of fall risk in older adults. The study's findings align with the American Heart Association's 2025 Joint Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. The guideline recommends annual blood pressure monitoring for all adults. Home blood pressure monitoring is recommended for patients to help confirm office diagnosis of high blood pressure and to monitor, track progress and tailor care as part of an integrated care plan. 

Preventing falls in elderly adults should be a top priority. 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. Home blood pressure measurement can add helpful health information for older adults and, as shown in findings from prior studies, for most of the general public. We hope that older adults, their family members and caregivers will feel empowered to measure blood pressure regularly at home and share this data with their health care team to help inform their blood pressure and overall healthcare plan."

Frances Wang, Ph.D., M.S., study's presenting author, researcherBeth Israel Deaconess Medical Center, Boston

What are the study's key findings?

• Among 758 adults older than age 78, 34.5% had sustained high blood pressure (higher blood pressure readings in medical and home settings); 17.0% had white coat high blood pressure; 15.4% had masked high blood pressure; and 33.2% had normal blood pressure readings.
• During a median follow-up of nearly one year (350 days), almost 1 in 4 participants (23.4%) self-reported during follow-up that they had fallen at least once during the previous 12 months.
• When office and home blood pressure differences were analyzed continuously, lower office blood pressure relative to home blood pressure was associated with a higher incidence of falls.

"Our analysis indicates that home blood pressure monitoring provides valuable information for clinical assessment, can help guide treatment decisions and may identify patients with hidden fall risk," said Dr. Wang. "This information can be particularly important to incorporate into patient care since falls are a major cause of disability and loss of independence among older adults."

"These findings confirm that 'normal' office blood pressure isn't always the end of the story," said Karol E. Watson, M.D., Ph.D., FAHA, a volunteer expert for the American Heart Association. "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. This deserves a closer look because falls can often accelerate decline in both physical and mental function for patients when physical independence is lost. This study doesn't explain why the fall risk was higher, but it may be telling us something about blood pressure variability and how well older adults are able to regulate their blood pressure (or not) throughout the day. Reducing the risk of falls should be a routine consideration, particularly in older adults with high blood pressure." Watson, who was not involved in this study, is the John Mazziotta, M.D., Ph.D., Chair of Medicine at the David Geffen School of Medicine at UCLA in Los Angeles.

What are the details, background and design of the study?  

• The study included 758 adults who were part of the community-based Atherosclerosis Risk in Communities (ARIC) study. ARIC began enrolling participants in 1985, and participants lived in four different communities in the U.S.: Forsyth County, North Carolina; Jackson, Mississippi; eight northern suburbs of Minneapolis, Minnesota; and Washington County, Maryland.
• Participants were 78-98 years old, representing a rapidly growing population in the U.S. that is under-studied. The median age was 83 years, and 59% were women. 17% of participants self-identified as Black adults.
• Of the participants, 82% were already taking medication to lower their blood pressure. 
• Multiple blood pressure readings were taken for all participants: in a doctor's office (three readings obtained one minute apart after a five-minute seated rest) and with a take-home blood pressure monitor, blood pressure readings were taken in the morning and evening over 8 non-consecutive days at home in 2023.
• Participants self-reported the number of falls experienced in the previous 12 months, during annual phone calls with their healthcare team.