Older adults with masked high blood pressure—normal readings in the doctor's office but elevated blood pressure at home—face a 70% higher risk of falls compared to those with sustained high blood pressure in both settings, according to preliminary research presented at the American Heart Association's Hypertension Scientific Sessions 2026 in Arlington, Virginia.
The study, which included 758 adults aged 78 to 98 from the community-based Atherosclerosis Risk in Communities (ARIC) study, found that 15.4% had masked hypertension, 34.5% had sustained high blood pressure, 17.0% had white coat hypertension, and 33.2% had normal readings. During a median follow-up of 350 days, nearly one in four participants (23.4%) reported falling at least once in the previous year. Notably, white coat hypertension—high office readings but normal at home—was linked to a lower fall risk.
Falls are the leading cause of disability and functional decline in adults 65 and older, according to the U.S. Centers for Disease Control and Prevention. While low blood pressure is typically considered a fall risk, emerging evidence suggests that high home blood pressure may also contribute.
"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.
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 and home monitoring to confirm diagnoses and tailor care. "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," Wang added.
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. This deserves a closer look because falls can often accelerate decline in both physical and mental function."
The study's implications are significant for an aging U.S. population. With home blood pressure monitors becoming more accessible, older adults and their caregivers are encouraged to measure blood pressure regularly at home and share data with healthcare teams. The American Heart Association provides resources such as Understanding Blood Pressure Readings to help the public interpret results. The full abstract will be published in the Hypertension Scientific Sessions 2026 Supplement of the Hypertension journal on November 17, 2026.
As the population ages, identifying modifiable risk factors for falls becomes critical. This study underscores the potential of home blood pressure monitoring to detect masked hypertension and prevent falls, a major cause of disability and loss of independence. For more information on high blood pressure risks, visit Health Threats from High Blood Pressure and Find High Blood Pressure Tools and Resources.
