High prevalence of masked uncontrolled hypertension in people with treated hypertension
High prevalence of masked uncontrolled hypertension in people with treated hypertension
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DOI：
10.1093/eurheartj/ehu016
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发表时间：
2014-12-07
影响因子：
39.3
通讯作者：
Williams, Bryan
中科院分区：
文献类型：
--
作者：
Banegas, Jose R.;Ruilope, Luis M.;Williams, Bryan
目的：关于正常日常生活中血压（BP）控制治疗质量的数据有限，特别是在血压治疗和看似控制良好的人群中，“隐性未控制高血压”（MUCH）的患病率尚不清楚。这一点很重要，因为未接受治疗的隐匿性高血压患者与心血管事件的高风险相关。因此，我们进行了首次研究，在常规临床实践的大样本高血压患者中定义了MUCH的患病率和特征，这些患者的血压接受治疗并控制到推荐的临床血压目标。方法和结果我们分析了来自西班牙高血压协会动态血压监测（ABPM）登记处的数据，并根据现行国际指南（临床血压< 140/90 mmHg）确定了接受治疗和控制血压的患者。如果这些患者的临床血压得到控制，但24小时平均ABPM仍然升高（24小时收缩期血压>= 130 mmHg和/或24小时舒张期血压>= 80 mmHg），则诊断为隐匿性未控制高血压。从西班牙登记的62 788例接受治疗的BP患者中，我们确定了14 840例接受治疗和控制的临床BP，其中4608例（31.1%）患者根据24小时ABPM标准患有MUCH（平均年龄59.4岁，男性59.7%）。男性、边缘血压（130-9/80-9 mmHg）患者和心血管高危患者（吸烟者、糖尿病、肥胖）中MUCH的患病率明显较高。隐匿不受控制的高血压最常见的原因是夜间血压控制不佳，而MUCH仅归因于夜间血压升高的患者比例几乎是仅归因于白天血压升高的患者比例的两倍（24.3 vs 12.9%, P < 0.001）。结论在治疗后血压控制良好的患者中，隐蔽性血压控制不佳的发生率较高。因此，单纯的临床血压监测不足以优化血压控制，因为许多患者夜间血压升高。这些发现表明，ABPM应成为确认血压控制的常规检查，特别是在高危人群和/或临床血压控制处于临界状态的人群中。
Aim There are limited data on the quality of treated blood pressure (BP) control during normal daily life, and in particular, the prevalence of 'masked uncontrolled hypertension' (MUCH) in people with treated and seemingly well-controlled BP is unknown. This is important because masked hypertension in 'treatment naive' patients is associated with a high risk of cardiovascular events. We therefore conducted the first study to define the prevalence and characteristics of MUCH among a large sample of hypertensive patients in routine clinical practice in whom BP was treated and controlled to recommended clinic BP goals.Methods and results We analysed data fromthe Spanish Society of Hypertension ambulatory blood pressure monitoring (ABPM) Registry and identified patients with treated and controlled BP according to current international guidelines (clinic BP < 140/90 mmHg). Masked uncontrolled hypertension was diagnosed in these patients if despite controlled clinic BP, the mean 24-h ABPM average remained elevated (24-h systolic BP >= 130 mmHg and/or 24-h diastolic BP >= 80 mmHg). From 62 788 patients with treated BP in the Spanish registry, we identified 14 840 with treated and controlled clinic BP, of whom 4608 patients (31.1%) had MUCH according to 24-h ABPM criteria (mean age 59.4 years, 59.7% men). The prevalence of MUCH was significantly higher in males, patients with borderline clinic BP (130-9/80-9 mmHg), and patients at high cardiovascular risk (smokers, diabetes, obesity). Masked uncontrolled hypertension was most often because of poor control of nocturnal BP, with the proportion of patients in whom MUCH was solely attributable to an elevated nocturnal BP almost double that solely attributable to daytime BP elevation (24.3 vs. 12.9%, P < 0.001).Conclusion The prevalence of masked suboptimal BP control in patients with treated and well-controlled clinic BP is high. Clinic BP monitoring alone is thus inadequate to optimize BP control because many patients have an elevated nocturnal BP. These findings suggest that ABPM should become more routine to confirm BP control, especially in higher risk groups and/or those with borderline control of clinic BP.