Prognostic Value of Masked Uncontrolled Hypertension.
Prognostic Value of Masked Uncontrolled Hypertension.
复制标题
DOI：
10.1161/hypertensionaha.118.11499
复制
发表时间：
2018-10
期刊：
影响因子：
--
通讯作者：
Staessen JA
中科院分区：
文献类型：
--
作者：
Pierdomenico SD;Pierdomenico AM;Coccina F;Clement DL;De Buyzere ML;De Bacquer DA;Ben-Dov IZ;Vongpatanasin W;Banegas JR;Ruilope LM;Thijs L;Staessen JA
隐匿性不受控制的高血压（MUCH）的预后相关性尚不完全清楚，其对心血管结局和死亡率的全球影响尚未评估。本研究的目的是对 MUCH 的预后价值进行荟萃分析。我们检索了评估 MUCH 患者与高血压受控患者结果的文章，并报告了调整后的风险比和 95% 置信区间。我们确定了六项使用动态血压监测的研究（12610 名患者，933 项事件）和五项使用家庭血压测量的研究（17742 名患者，394 项事件）。全球人口包括 30352 名患者，他们经历了 1327 起事件。选定的研究将心血管结局和全因死亡率作为主要结局，主要结果是这些事件的综合结果。 MUCH 与受控高血压的总体调整风险比为 1.80（95% 置信区间 1.57-2.06）。亚组荟萃分析显示，使用动态血压监测的研究调整后的风险比为 1.83（95% 置信区间 1.52-2.21），使用家庭血压测量的研究调整后的风险比为 1.75（95% 置信区间 1.38-2.20）。 MUCH 患者的风险显着高于受控高血压患者，与随访时间长度和研究事件类型无关。在所有种族群体中，许多人的高血压风险均显着高于受控制的高血压，但在包括黑人患者的研究中发现风险比最高。 MUCH 患者发生心血管事件和全因死亡率的风险显着高于高血压得到控制的患者。通过动态或家庭血压测量检测到的许多结果似乎传达了类似的预后信息。
The prognostic relevance of masked uncontrolled hypertension (MUCH) is incompletely clear and its global impact on cardiovascular outcomes and mortality has not been assessed. The aim of this study was to perform a meta-analysis on the prognostic value of MUCH. We searched for articles assessing outcome in patients with MUCH compared to those with controlled hypertension and reporting adjusted hazard ratio and 95% confidence interval. We identified six studies using ambulatory blood pressure monitoring (12610 patients with 933 events) and five using home blood pressure measurement (17742 patients with 394 events). The global population included 30352 patients who experienced 1327 events. Selected studies had cardiovascular outcomes and all-cause mortality as primary outcome and the main result is a composite of these events. The overall adjusted hazard ratio was 1.80 (95% confidence interval 1.57–2.06) for MUCH versus controlled hypertension. Subgroup meta-analysis showed that adjusted hazard ratio was 1.83 (95% confidence interval 1.52–2.21) in studies using ambulatory blood pressure monitoring and 1.75 (95% confidence interval 1.38–2.20) in those using home blood pressure measurement. Risk was significantly higher in MUCH than in controlled hypertension independently of follow-up length and types of studied events. MUCH was at significantly higher risk than controlled hypertension in all ethnic groups, but the highest hazard ratio was found in studies including Black patients. Risk of cardiovascular events and all-cause mortality is significantly higher in patients with MUCH than in those with controlled hypertension. MUCH detected by ambulatory or home blood pressure measurement appear to convey similar prognostic information.