Adults older than 78 with masked hypertension—normal blood pressure readings in a medical setting but elevated readings at home—had a 70% higher risk of falls compared with those who had sustained high blood pressure in both settings, according to preliminary research presented at the American Heart Association's Hypertension Scientific Sessions 2026. The meeting, held in Arlington, Virginia, October 7–11, 2026, is a premier scientific exchange focused on recent advances in high blood pressure research.
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 typically considered a fall risk, emerging evidence suggests that high home blood pressure is also associated with increased fall incidence 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, 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 the study's presenting author Frances Wang, Ph.D., M.S., 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. 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."
The study included 758 adults aged 78–98 from the community-based 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. During a median follow-up of 350 days, 23.4% of participants self-reported at least one fall 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.
"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," Dr. Wang said. "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."
Karol E. Watson, M.D., Ph.D., FAHA, a volunteer expert for the American Heart Association, noted that the findings confirm "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 said. "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."
The study's implications are significant for older adults, their caregivers, and healthcare providers. With home blood pressure monitoring becoming more accessible, these findings support its use as a tool to identify hidden risks and prevent falls. As the population ages, addressing fall risk becomes increasingly critical. The American Heart Association provides resources such as Health Threats from High Blood Pressure and Understanding Blood Pressure Readings to help the public manage their health. Additional tools are available at Find High Blood Pressure Tools and Resources. For more information on heart health, visit heart.org and stroke.org.
