Failure to show benefit in some cardiovascular and renal outcome trials may be a consequence of masked hypertension, a blood pressure in the hypertensive range outside the office setting. Ambulatory blood pressure monitoring and home blood pressures obtained by the patient are superior to office blood pressure for assessing individual target-organ damage and predicting cardiovascular disease morbidity and mortality. Lastly, masked hypertension is associated with an increased risk of developing primary hypertension and can be treated with either short-acting medications or improvement of underlying causes. We review the clinical impact of masked hypertension on cardiovascular risk and progression of kidney disease. We further propose a clinical management paradigm specific for masked hypertension that needs confirmation in a clinical trial.