Reproducibility of masked uncontrolled hypertension detected through home blood pressure monitoring
Reproducibility of masked uncontrolled hypertension detected through home blood pressure monitoring
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DOI：
10.1111/jch.13596
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发表时间：
2019-07-01
影响因子：
2.8
通讯作者：
Giunta, Diego
中科院分区：
文献类型：
--
作者：
Barochiner, Jessica;Posadas Martinez, Maria Lourdes;Giunta, Diego
隐匿性不受控制的高血压（MUCH）是在接受治疗的高血压受试者中描述的一种实体，其中办公室血压（BP）控制良好，而办公室外血压升高。它与更高的心血管风险有关。然而，MUCH的可重复性几乎没有研究。在这项研究中，我们的目的是确定通过家庭血压监测（HBPM）检测的MUCH的重现性。在稳定治疗的高血压成人中进行了两组测量，间隔1周。每组测量包括三个办公室BP读数和4天HBPM，在早上、下午和晚上重复读数（在两种设置中使用相同的经验证的血压测量装置）。我们确定了两组测量结果中MUCH存在的一致性百分比，并通过Cohen kappa系数（kappa）、95%置信区间和P值量化了这种一致性。我们纳入了105例患者（中位年龄58.6 [IQR 45.6-67.2]岁，53.4%为男性）。至少一次MUCH的患病率为22.3%（95% CI：15.2-31.5）。MUCH的重复性较差：kappa = 0.19（95% CI：0.0002-0.38），P = 0.02，由于与家庭BP组分相比，MUCH的办公室BP组分的重现性较差：kappa = 0.21（95%CI：0.03-0.39），P = 0.01 vs kappa = 0.48（95%CI 0.29-0.67），P < 0.001。总之，通过HBPM检测到的MUCH的重现性很小，主要是由于办公室BP测量的重现性差。基于HBPM的MUCH患者管理策略在心血管发病率和死亡率方面可能更充分。
Masked uncontrolled hypertension (MUCH) is an entity described in treated hypertensive subjects, where office blood pressure (BP) is well controlled and out-of-office BP is elevated. It has been related to a higher cardiovascular risk. However, the reproducibility of MUCH has been scarcely studied. In this study, we aimed to determine the reproducibility of MUCH detected through home blood pressure monitoring (HBPM). Two sets of measurements were performed in hypertensive adults under stable treatment with a 1-week interval. Each set of measurements included three office BP readings and a 4-day HBPM with duplicate readings in the morning, afternoon, and evening (the same validated oscillometric device was employed in both settings). We determined the percentage of agreement regarding the presence of MUCH in the two sets of measurements and quantified such agreement through the Cohen's kappa coefficient (kappa), its 95% confidence interval, and P value. We included 105 patients (median age 58.6 [IQR 45.6-67.2] years old, 53.4% men). MUCH prevalence on at least one occasion was 22.3% (95% CI: 15.2-31.5). The reproducibility of MUCH was scant: kappa = 0.19 (95% CI: 0.0002-0.38), P = 0.02, due to the poor reproducibility of the office BP component of MUCH in comparison with the home BP component: kappa = 0.21 (95% CI: 0.03-0.39), P = 0.01 vs kappa = 0.48 (95% CI 0.29-0.67), P < 0.001, respectively. In conclusion, the reproducibility of MUCH detected through HBPM is minimal, mainly due to the poor reproducibility of office BP measurements. An HBPM-based strategy for the management of patients with MUCH may be more adequate in terms of cardiovascular morbidity and mortality.