Prognosis of "masked" hypertension and "white-coat" hypertension detected by 24-h ambulatory blood pressure monitoring - 10-year follow-up from the Ohasama Study
Prognosis of "masked" hypertension and "white-coat" hypertension detected by 24-h ambulatory blood pressure monitoring - 10-year follow-up from the Ohasama Study
复制标题
DOI：
10.1016/j.jacc.2005.03.070
复制
发表时间：
2005-08-02
影响因子：
24
通讯作者：
Imai, Y
中科院分区：
文献类型：
--
作者：
Ohkubo, T;Kikuya, M;Imai, Y
目的 我们试图研究“白大衣”高血压 (WCHT) 和“隐匿性”高血压 (MHT) 受试者的预后，其中临床测量的血压 (BP) 低于动态监测期间的血压。 背景 WCHT 的预后意义仍存在争议，并且对 MHT 知之甚少。 方法 我们从以下来源获得了 24 小时动态血压和“偶然”血压（即在临床场景中获得）值。日本社区一般人群的代表性样本中有 1,332 名受试者（872 名女性，460 名男性）>= 40 岁。然后对生存和中风发病率进行平均持续 10 年的随访。 结果 对于 WCHT 受试者，使用 Cox 比例风险回归模型检查心血管死亡和中风发病率的复合风险（休闲血压 >= 140/90 mm Hg，日间血压 < 135/85 mm Hg；相对风险 [RH]）1.28； 95% 置信区间 [CI] 0.76 至 2.14）与血压持续正常的受试者（偶然血压 < 140/90 mm Hg，日间血压 < 135/85 mm Hg）的风险没有差异。然而，患有 MHT（偶然血压 < 140/90 mm Hg，白天血压 >= 135/85 mm Hg；RH 2.13；95% CI 1.38 至 3.29）或持续性高血压（偶然血压 >= 140/90 mm Hg，白天血压 >= 135/85 mm Hg；RH 2.26；或持续性高血压）受试者的风险显着较高。 95% CI 1.49 至 3.41）比血压持续正常的受试者低。在按性别、抗高血压药物使用和危险因素水平划分的亚组中，心血管死亡率和中风发病率也观察到了类似的结果（所有异质性 p > 0.2）。 结论 传统血压测量可能无法识别某些高风险或低风险个体，但可以通过使用动态血压来识别这些人。
OBJECTIVES We sought to investigate the prognosis in subjects with "white-coat" hypertension (WCHT) and "masked" hypertension (MHT), in which blood pressure (BP) is lower in clinical measurements than during ambulatory monitoring.BACKGROUND The prognostic significance of WCHT remains controversial, and little is known about MHT.METHODS We obtained 24-h ambulatory BP and "casual" BP (i.e., obtained in clinical scenarios) values from 1,332 subjects (872 women, 460 men) >= 40 years old in a representative sample of the general population of a Japanese community. Survival and stroke morbidity were then followed up for a mean duration of 10 years.RESULTS Composite risk of cardiovascular mortality and stroke morbidity examined using a Cox proportional hazards regression model for subjects with WCHT (casual BP >= 140/90 mm Hg, daytime BP < 135/85 mm Hg; relative hazards [RH])1.28; 95% confidence interval [CI] 0.76 to 2.14) was no different from risk for subjects with sustained normal BP (casual BP < 140/90 mm Hg, daytime BP < 135/85 mm Hg). However, risk was significantly higher for subjects with MHT (casual BP < 140/90 mm Hg, daytime BP >= 135/85 mm Hg; RH 2.13; 95% CI 1.38 to 3.29) or sustained hypertension (casual BP >= 140/90 mm Hg, daytime BP >= 135/85 mm Hg; RH 2.26; 95% CI 1.49 to 3.41) than for subjects with sustained normal BP. Similar findings were observed for cardiovascular mortality and stroke morbidity among subgroups by gender, use of antihypertensive medication, and risk factor level (all p for heterogeneity > 0.2).CONCLUSIONS Conventional BP measurements may not identify some individuals at high or low risk, but these people may be identifiable by the use of ambulatory BP.