Masked Hypertension and Incident Clinic Hypertension Among Blacks in the Jackson Heart Study.
Masked Hypertension and Incident Clinic Hypertension Among Blacks in the Jackson Heart Study.
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DOI：
10.1161/hypertensionaha.115.06904
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发表时间：
2016-07
期刊：
影响因子：
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通讯作者：
Shimbo D
中科院分区：
文献类型：
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作者：
Abdalla M;Booth JN 3rd;Seals SR;Spruill TM;Viera AJ;Diaz KM;Sims M;Muntner P;Shimbo D
隐匿性高血压，定义为临床血压未升高和临床外血压升高，可能是血压正常向高血压发展的中间阶段。在Jackson心脏研究中，我们对非裔美国人进行前瞻性队列研究，通过动态血压监测和临床高血压事件，研究了门诊外血压和隐匿性高血压的关系。分析包括317名临床血压<140/90mmHg，完全ABPM， 2000-2004年基线时未服用抗高血压药物的参与者。隐匿性日间高血压定义为：平均日间血压≥135/85mmHg；掩盖夜间高血压为平均夜间血压≥120/70mmHg；24小时平均血压≥130/80mmHg。在2005-2008年和2009-2012年的研究访问中评估的临床高血压事件定义为首次就诊时临床收缩压/舒张压≥140/90mmHg或使用抗高血压药物。在中位随访8.1年期间，187例（59.0%）发生临床高血压。有隐匿性高血压和无隐匿性高血压的受试者分别有79.2%和42.2%、有和无隐匿性日间高血压和85.7%和50.4%、有和无隐匿性夜间高血压和79.9%和43.7%、有和无隐匿性24小时高血压分别有85.7%和48.2%发生临床高血压。任何隐匿性高血压和隐匿性白天、夜间和24小时高血压的临床高血压事件的多变量校正危险比（95% CI）分别为2.13（1.51-3.02）、1.79（1.24-2.60）、2.22（1.58-3.12）和1.91（1.32-2.75）。这些发现表明，动态血压监测可以识别非裔美国人患高血压的风险增加。
Masked hypertension, defined as non-elevated clinic blood pressure and elevated out-of-clinic blood pressure may be an intermediary stage in the progression from normotension to hypertension. We examined the associations of out-of-clinic blood pressure and masked hypertension using ambulatory blood pressure monitoring with incident clinic hypertension in the Jackson Heart Study, a prospective cohort of African Americans. Analyses included 317 participants with clinic blood pressure <140/90mmHg, complete ABPM, who were not taking antihypertensive medication at baseline in 2000–2004. Masked daytime hypertension was defined as mean daytime blood pressure ≥135/85mmHg; masked nighttime hypertension as mean nighttime blood pressure ≥120/70mmHg; and masked 24-hour hypertension as mean 24-hour blood pressure ≥130/80mmHg. Incident clinic hypertension, assessed at study visits in 2005–2008 and 2009–2012, was defined as the first visit with clinic systolic/diastolic blood pressure ≥140/90mmHg or antihypertensive medication use. During a median follow-up of 8.1 years, there were 187 (59.0%) incident cases of clinic hypertension. Clinic hypertension developed in 79.2% and 42.2% of participants with and without any masked hypertension, 85.7% and 50.4% with and without masked daytime hypertension, 79.9% and 43.7% with and without masked nighttime hypertension and 85.7% and 48.2% with and without masked 24-hour hypertension, respectively. Multivariable-adjusted hazard ratios (95% CI) of incident clinic hypertension for any masked hypertension and masked daytime, nighttime, and 24-hour hypertension were 2.13 (1.51–3.02), 1.79 (1.24–2.60), 2.22 (1.58–3.12), and 1.91 (1.32–2.75), respectively. These findings suggest that ambulatory blood pressure monitoring can identify African Americans at increased risk for developing clinic hypertension.