Masked hypertension in obstructive sleep apnea syndrome
Masked hypertension in obstructive sleep apnea syndrome
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DOI：
10.1097/hjh.0b013e3282f55049
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发表时间：
2008-05-01
影响因子：
4.9
通讯作者：
Pepin, Jean-Louis
中科院分区：
文献类型：
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作者：
Bagueta, Jean-Philippe;Levy, Patrick;Pepin, Jean-Louis
背景动态血压监测（ABPM）检测临床正常但动态24小时血压高的受试者，即隐匿性高血压。方法纳入130例新诊断的无心血管疾病的阻塞性睡眠呼吸暂停综合征（OSAS）患者(男性111例，年龄48±1岁，BMI = 27.6±0.4 kg/m(2)，呼吸障碍指数（RDI = 42±2/h）。评估临床血压、24h ABPM、压力反射敏感性（BRS）、超声心动图及颈动脉内膜-中膜厚度（IMT）。结果血压正常41例（31.5%），隐匿性高血压39例（30.0%），白大衣高血压4例（3.1%），高血压46例（35.4%）。在BRS（分别为10.5 +/- 0.8、8.0 +/- 0.6和7.4 +/- 0.4ms/mmHg， P< 0.001）、颈动脉IMT（分别为624 +/- 17、650 +/- 20和705 +/- 23mm， P = 0.04）和左心室容积指数（分别为37 +/- 1、40 +/- 2和43 +/- 1g/height 2.7, P = 0.003）方面，正常高血压、隐伏高血压和高血压患者存在显著差异。临床收缩压大于125和舒张压大于83 mmHg导致相对风险（RR）为2.7，隐匿性高血压的阳性预测值为90%。结论隐匿性高血压常被低估，当临床血压高于125/83mmHg时，隐匿性高血压几乎总是存在。
Background Ambulatory blood pressure (BP) monitoring (ABPM) detects subjects with normal clinic but high ambulatory 24-h BP, that is, masked hypertension.Methods One hundred and thirty newly diagnosed obstructive sleep apnea syndrome (OSAS) patients, free of recognized cardiovascular disease were included (111 men, age = 48 +/- 1 years, BMI = 27.6 +/- 0.4 kg/m(2), respiratory disturbance index (RDI = 42 +/- 2/h). Clinic BP, 24-h ABPM, baroreflex sensitivity (BRS), echocardiography and carotid intima - media thickness (IMT) were assessed.Results Forty-one patients (31.5%) were normotensive, 39 (30.0%) exhibited masked hypertension, four (3.1%) white-coat hypertension and 46 (35.4%) hypertension. Significant differences were found between normotensive, masked hypertensive and hypertensive patients in terms of BRS (10.5 +/- 0.8, 8.0 +/- 0.6 and 7.4 +/- 0.4ms/mmHg, respectively, P< 0.001), carotid IMT (624 +/- 17, 650 +/- 20 and 705 +/- 23mm, respectively, P = 0.04) and left ventricularmass index (37 +/- 1, 40 +/- 2 and 43 +/- 1g/height 2.7, respectively, P = 0.003). Aclinic systolic BP more than 125 and a diastolic BP more than 83 mmHg led to a relative risk (RR) of 2.7 and a 90% positive predictive value for having masked hypertension.Conclusion Masked hypertension is frequently underestimated in OSAS and is nearly always present when clinic BP is above 125/83mmHg.