Reflections on masked hypertension.
Reflections on masked hypertension.
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对隐匿性高血压的思考。
DOI：
10.1016/j.amjhyper.2005.08.002
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发表时间：
2005
影响因子：
3.2
通讯作者：
D. Clement
中科院分区：
文献类型：
--
作者：
D. Clement
乔治皮克林爵士和莫里斯索科洛夫的开创性文章充分说明了动态血压监测的潜力，特别是在诊断高血压方面。最近的研究强调了动态血压（BP）在预测心血管事件方面的预后价值超过办公室血压。1在动态血压曲线中已经描述了几种模式，很多注意力都集中在孤立的办公室高血压（办公室血压升高和正常的动态血压）。最近，另一个特征被描述为包括正常的办公室血压，但动态血压升高。这种情况被称为隐性高血压。2这一情况的几个方面仍需澄清。首先，目前尚不清楚同一定义是否适用于治疗和未治疗的高血压。更重要的是，隐性高血压的预后价值仍在研究中。在最近的一篇文章中，它表明，隐匿性高血压对治疗的老年高血压患者的预后有负面影响。3在本期的《美国高血压杂志》上，Pierdomenico等4进一步分析了这个问题。他们评估了340例高血压反应患者（诊室血压和日间动态血压正常）和126例高血压隐性患者（诊室血压140/90 mm Hg和日间血压135/85 mm Hg）5年期间的心血管事件。校正包括门诊血压在内的几个协变量后，考克斯回归分析显示，与应答者高血压相比，隐匿性高血压的心血管风险显著更高（相对风险[RR] 2.28，95% CI 1.1-4.7，P.05）。这一信息很重要，因为它证实了Bobrie等人3的数据，并且肯定遵循逻辑思维：血压高的时间越长，心血管事件的风险越高。对这篇文章的仔细分析值得等待进一步的确认。本研究中研究的人群可能与常规高血压诊所中观察到的人群不同。研究人员发现，隐匿性高血压的患病率非常高（742名患者中有340名）。作为参考，在门诊与门诊（OvA）研究中，1患病率为143/1963。此外，
The pioneering articles by Sir George Pickering and Maurice Sokoloff have amply illustrated the potential of ambulatory blood pressure monitoring, especially in the diagnosis of hypertension. Recent work has highlighted the prognostic value of ambulatory blood pressure (BP) in predicting cardiovascular events over and above office BP. 1 Several patterns have been described in the ambulatory BP curve, A lot of attention has been devoted to isolated office hypertension (elevated office BP and normal ambulatory day BP). Recently, another feature was described consisting of normal office BP but elevated ambulatory BP. This condition was called masked hypertension. 2 Several aspects of this condition still need clarification. First, it is not clear yet whether the same definition can be applied for treated and untreated hypertension. Much more important, the prognostic value of masked hypertension is still under investigation. In a recent article, it was shown that masked hypertension has a negative impact on prognosis in treated elderly hypertensive patients. 3 In the present issue of the American Journal of Hypertension, Pierdomenico et al 4 further analyzed the question. They evaluated cardiovascular events during 5 years in 340 patients with responder hypertension (normal office and daytime ambulatory BP) and 126 with masked hypertension (clinic BP 140/90 mm Hg and daytime BP 135/85 mm Hg). After adjustment for several covariates, including clinic BP, Cox regression analysis showed that cardiovascular risk was significantly higher in masked hypertension compared to responder hypertension (relative risk [RR] 2.28, 95% CI 1.1–4.7, P. 05). This information is important as it confirms the data of Bobrie et al 3 and certainly follows logical thinking: the longer time BP is high, the higher the risk for cardiovascular events. Careful analysis of this article warrants waiting for further confirmation. The population studied in this study may be different from that seen in regular hypertension clinics. The investigators come up with a very high prevalence of masked hypertension (340 of 742 patients). For reference, in the Office vs. Ambulatory (OvA) study, 1 prevalence was 143 of 1963. Also the total number of