Subtypes of masked hypertension and target organ damage in untreated outpatients
Subtypes of masked hypertension and target organ damage in untreated outpatients
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未经治疗的门诊患者隐匿性高血压的亚型和靶器官损伤
DOI：
10.1080/08037051.2020.1763159
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发表时间：
2020
期刊：
影响因子：
1.8
通讯作者：
Li Yan
中科院分区：
文献类型：
--
作者：
Zhang Dong-Yan;Cheng Yi-Bang;Guo Qian-Hui;Wang Ying;Sheng Chang-Sheng;Huang Qi-Fang;An De-Wei;Li Ming-Xuan;Huang Jian-Feng;Xu Ting-Yan;Wang Ji-Guang;Li Yan
摘要目的：隐匿性高血压（MHT）的特征是在存在非办公室高血压的情况下的办公室正常血压，并且可以根据高血压存在的时间进一步分类为孤立白天（dMHT），夜间（nMHT）或昼夜MHT（dnMHT）。MHT与不良心血管结局相关。然而，以前没有研究对比这些MHT亚型与靶器官损伤（TOD）的关系。材料与方法：招募了连续未治疗的患者，他们被转诊到我们的高血压诊所进行动态血压（BP）监测。分别使用Omron 7051和SpaceLabs 90217监测仪测量办公室和门诊血压。白天和夜间高血压的血压阈值分别为≥135/85 mmHg和≥120/70 mmHg。我们进行了各种TOD测量，包括颈动脉-股动脉脉搏波速度（cfPWV）、颈动脉内膜-中层厚度（cIMT）、左心室质量指数（LVMI）和E/E '、估计肾小球滤过率（eGFR）和尿白蛋白/肌酐比值（UACR）。结果如下：1808名参与者（平均年龄51岁;女性，52%）包括672名（37.2%）MHT受试者，其中123名（18.3%）患有dMHT，78名（11.6%）患有nMHT，471名（70.1%）患有dnMHT。在所有参与者以及诊室血压正常的患者（n = 1222）中，多变量校正后，日间和夜间动态血压与所有TOD测量值（p ≥ 0.20）相似。与血压正常的人相比（p < 0.05），dMHT患者的cfPWV更快，（7.81与7.58 m/s）和更厚的cIMT（637.6与610.4 µm），nMHT患者的cIMT较厚（641.8与610.4 µm）和UACR增加（0.79 vs. 0.59 mg/mmol），而dnMHT患者的上述TOD指标均较差，eGFR升高（120.7 vs. 116.8 ml/min/1.73 m2）。结论：MHT与TOD相关，无论亚型如何，尽管TOD在这些亚型之间略有不同。这项研究强调了控制高血压患者白天和夜间血压的重要性。
Abstract Purpose: Masked hypertension (MHT) is characterised as an office normotension in the presence of out-of-office hypertension, and can be further categorised as isolated daytime (dMHT), night-time (nMHT) or day-night MHT (dnMHT) according to the time when hypertension is present. MHT is associated with adverse cardiovascular outcome. However, no previous studies contrasted these MHT subtypes in their associations with target organ damage (TOD). Materials and methods: Consecutive untreated patients referred for ambulatory blood pressure (BP) monitoring to our Hypertension Clinic were recruited. Office and ambulatory BPs were measured using the Omron 7051 and SpaceLabs 90217 monitors, respectively. The BP thresholds of daytime and night-time hypertension were of ≥135/85 mmHg and ≥120/70 mmHg, respectively. We performed various TOD measurements, including carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (cIMT), left ventricular mass index (LVMI) and E/E’, estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR). Results: The 1808 participants (mean age, 51 years; women, 52%) included 672 (37.2%) MHT subjects, among whom 123 (18.3%) had dMHT, 78 (11.6%) nMHT, and 471 (70.1%) dnMHT. In all participants as well as patients with office normotension (n = 1222), ambulatory daytime and night-time BPs were similarly associated with all TOD measurements (p ≥ 0.20) after multivariate adjustment. Compared to normotensive subjects (p < 0.05), patients with dMHT had faster cfPWV (7.81 vs. 7.58 m/s) and thicker cIMT (637.6 vs. 610.4 µm), patients with nMHT had thicker cIMT (641.8 vs. 610.4 µm) and increased UACR (0.79 vs. 0.59 mg/mmol), and patients with dnMHT had all worse TOD measures mentioned-above plus elevated eGFR (120.7 vs. 116.8 ml/min/1.73m2). Conclusion: MHT was associated with TOD irrespective of subtype, although TOD varied slightly across these subtypes. The study highlights the importance of controlling both daytime and night-time BP in hypertensive patients.