Comparison of the association of masked hypertension defined by the 2017 ACC/AHA BP guideline versus the JNC7 guideline with left ventricular hypertrophy.
Comparison of the association of masked hypertension defined by the 2017 ACC/AHA BP guideline versus the JNC7 guideline with left ventricular hypertrophy.
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DOI：
10.1097/hjh.0000000000003192
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发表时间：
2022-08-01
影响因子：
4.9
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中科院分区：
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与全国联合委员会第七次报告（JNC7）相比，2017年美国心脏病学会/美国心脏协会（ACC/AHA）血压（BP）指南使用较低的血压阈值来定义高血压和血压控制。我们汇总了5项美国研究的数据，比较隐匿性高血压（MHT）和隐匿性未控制高血压的相关性，隐匿性高血压的定义采用2017年ACC/AHA指南（n = 1653，无高血压，<130/80 mmHg）与JNC7指南（n = 2451，无高血压，<140/90 mmHg），伴有左心室肥厚（LVH）。MHT和隐匿性未控制高血压分别用办公室血压、清醒血压和清醒、睡眠或24小时血压来定义。超声心动图评估LVH。在未服用抗高血压药物的无高位血压的参与者中，JNC7指南和2017年ACC/AHA血压指南定义的MHT患病率在仅使用清醒血压时分别为25.0%和33.5%，在使用清醒、睡眠或24小时血压时分别为37.1%和52.0%。JNC7和2017 ACC/AHA血压指南定义的与MHT相关的LVH校正患病率比与持续正常血压相比，仅使用清醒血压时分别为1.72[95%可信区间（CI）： 1.12-2.64]和1.56 (95% CI: 0.97-2.51)，使用清醒、睡眠或24小时血压时分别为2.16 （95% CI: 1.36-3.44）和1.03 （95% CI: 0.58-1.82）。使用JNC7或2017年ACC/AHA血压指南中的血压阈值定义时，没有证据表明隐蔽性未控制的高血压与LVH相关。MHT与LVH的关联可能取决于所使用的BP阈值。
Compared with the Seventh Report of the Joint National Committee (JNC7), the 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline uses lower BP thresholds to define hypertension and BP control. We pooled data from five US-based studies to compare the association of masked hypertension (MHT) and masked uncontrolled hypertension, defined using the 2017 ACC/AHA guideline (n = 1653 without high office BP; <130/80 mmHg) versus the JNC7 guideline (n = 2451 without high office BP; <140/90 mmHg), with left ventricular hypertrophy (LVH). MHT and masked uncontrolled hypertension were defined using office BP and awake BP alone and awake, asleep, or 24-h BP. LVH was assessed by echocardiography. Among participants without high office BP not taking antihypertensive medication, the prevalence of MHT defined by the JNC7 guideline and the 2017 ACC/AHA BP guideline was 25.0 and 33.5% using awake BP only and 37.1 and 52.0% when using awake, asleep, or 24-h BP. The adjusted prevalence ratios for LVH associated with MHT versus sustained normotension defined by the JNC7 and 2017 ACC/AHA BP guidelines were 1.72 [95% confidence interval (CI): 1.12–2.64] and 1.56 (95% CI: 0.97–2.51), respectively, when using awake BP only and 2.16 (95% CI: 1.36–3.44) and 1.03 (95% CI: 0.58–1.82), respectively, when using awake, asleep or 24-h BP. There was no evidence that masked uncontrolled hypertension was associated with LVH when defined using the BP thresholds in either the JNC7 or the 2017 ACC/AHA BP guideline. The association of MHT with LVH may depend on the BP thresholds used.