Setting thresholds to varying blood pressure monitoring intervals differentially affects risk estimates associated with white-coat and masked hypertension in the population.
Setting thresholds to varying blood pressure monitoring intervals differentially affects risk estimates associated with white-coat and masked hypertension in the population.
复制标题
设置不同血压监测间隔的阈值会对人群中白大衣高血压和隐匿性高血压相关的风险估计产生不同的影响。
DOI：
10.1161/hypertensionaha.114.03614
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发表时间：
2014-11
期刊：
影响因子：
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通讯作者：
International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes (IDACO) Investigators
中科院分区：
文献类型：
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作者：
Asayama K;Thijs L;Li Y;Gu YM;Hara A;Liu YP;Zhang Z;Wei FF;Lujambio I;Mena LJ;Boggia J;Hansen TW;Björklund-Bodegård K;Nomura K;Ohkubo T;Jeppesen J;Torp-Pedersen C;Dolan E;Stolarz-Skrzypek K;Malyutina S;Casiglia E;Nikitin Y;Lind L;Luzardo L;Kawecka-Jaszcz K;Sandoya E;Filipovský J;Maestre GE;Wang J;Imai Y;Franklin SS;O'Brien E;Staessen JA;International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes (IDACO) Investigators
关于测量动态血压以诊断白大衣或隐匿性高血压的时间间隔，缺乏以结果为导向的建议。我们对参与 12 项人群研究的 8237 名未经治疗的参与者（平均年龄 50.7 岁；48.4% 女性）进行了交叉分类，使用 ≥140/≥90、≥130/≥80、≥135/≥85 和 ≥120/≥70 mm Hg 作为常规、24 小时、白天和夜间血压的高血压阈值。白大衣高血压是常规测量的高血压，动态血压正常，相反的情况是隐匿性高血压。用于对参与者进行分类的时间间隔为白天、夜间和 24 小时，首先单独考虑，然后组合为 24 小时加白天或加夜间，或两者兼而有之。根据选择的时间间隔，白大衣高血压和隐匿性高血压的发生率分别为 6.3% 至 12.5% 和 9.7% 至 19.6%。在 91 046 人年中，729 名参与者经历了心血管事件。在以一天中所有时间间隔血压正常为参考的多变量分析中，仅考虑白天（1.38；P=0.033）、仅夜间（1.43；P=0.0074）、仅24小时（1.21；P=0.20）、24小时加白天（1.24；P=0.18）、24小时加夜间，与白大衣高血压相关的风险比逐渐减弱(1.15； P=0.39），24 小时加上白天和夜间（1.16；P=0.41）。隐匿性高血压与正常血压的风险比均显着（P<0.0001），范围为 1.76 至 2.03。总之，识别真正低风险的白大衣高血压需要同时设定 24 小时、白天和夜间血压阈值。尽管按照现行指南的建议，任何时间间隔都足以诊断隐匿性高血压，但完整的 24 小时记录在临床实践中仍然是标准。
Outcome-driven recommendations about time intervals during which ambulatory blood pressure should be measured to diagnose white-coat or masked hypertension are lacking. We cross-classified 8237 untreated participants (mean age, 50.7 years; 48.4% women) enrolled in 12 population studies, using ≥140/≥90, ≥130/≥80, ≥135/≥85, and ≥120/≥70 mm Hg as hypertension thresholds for conventional, 24-hour, daytime, and nighttime blood pressure. White-coat hypertension was hypertension on conventional measurement with ambulatory normotension, the opposite condition being masked hypertension. Intervals used for classification of participants were daytime, nighttime, and 24 hours, first considered separately, and next combined as 24 hours plus daytime or plus nighttime, or plus both. Depending on time intervals chosen, white-coat and masked hypertension frequencies ranged from 6.3% to 12.5% and from 9.7% to 19.6%, respectively. During 91 046 person-years, 729 participants experienced a cardiovascular event. In multivariable analyses with normotension during all intervals of the day as reference, hazard ratios associated with white-coat hypertension progressively weakened considering daytime only (1.38; P=0.033), nighttime only (1.43; P=0.0074), 24 hours only (1.21; P=0.20), 24 hours plus daytime (1.24; P=0.18), 24 hours plus nighttime (1.15; P=0.39), and 24 hours plus daytime and nighttime (1.16; P=0.41). The hazard ratios comparing masked hypertension with normotension were all significant (P<0.0001), ranging from 1.76 to 2.03. In conclusion, identification of truly low-risk white-coat hypertension requires setting thresholds simultaneously to 24 hours, daytime, and nighttime blood pressure. Although any time interval suffices to diagnose masked hypertension, as proposed in current guidelines, full 24-hour recordings remain standard in clinical practice.