New preliminary research presented at the American Heart Association's Hypertension Scientific Sessions 2026 reveals that older adults with masked high blood pressure face a significantly elevated risk of falls. The study, which included 758 participants over age 78, found that masked hypertension—defined as normal blood pressure readings in a clinical setting but high readings at home—was associated with a 70% higher risk of falls compared with sustained hypertension, where blood pressure is high both in the office and at home. In contrast, white coat hypertension, characterized by high office readings but normal home readings, was linked to a lower fall risk.
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. Even though low blood pressure is typically considered a fall risk factor, this study adds to emerging evidence that high home blood pressure may also contribute to falls in older adults. The findings 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 for all adults and home monitoring to confirm office diagnoses and tailor care.
"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," said Frances Wang, Ph.D., M.S., the study's presenting author and a researcher at Beth Israel Deaconess Medical Center in Boston. "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."
The study analyzed data from the Atherosclerosis Risk in Communities (ARIC) study, with participants aged 78-98. 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 blood pressure. During a median follow-up of 350 days, 23.4% of participants 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 associated with a higher incidence of falls.
"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 who was not involved in the study. "This deserves a closer look because falls can often accelerate decline in both physical and mental function for patients when physical independence is lost."
The implications for clinical practice are significant. As home blood pressure monitoring becomes more accessible, healthcare professionals can use both office and home measurements to identify hidden risks. The American Heart Association provides resources such as Health Threats from High Blood Pressure and Understanding Blood Pressure Readings to help patients manage their condition. Additionally, tools like Find High Blood Pressure Tools and Resources can aid in tracking and treatment decisions.
This research underscores the importance of integrating home blood pressure monitoring into routine care for older adults, as it may reveal masked hypertension and help prevent falls, a major cause of disability and loss of independence. The study was funded by the American Heart Association and the National Institutes of Health and will be presented at 11:45 a.m. ET on Friday, October 9, 2026.
