Reproducibility and Clinical Implications of Masked Hypertension

隐匿性高血压的可重复性和临床意义

• 批准号: 7768929
• 负责人: ANTHONY J VIERA
• 金额: $ 55.92万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-06-01 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7768929
• 关键词: Address; Adult; Agreement; Albumins; Albuminuria; Ambulatory Blood Pressure Monitoring; Ambulatory Monitoring; Antihypertensive Agents; Atherosclerosis; Attention; Blood Pressure; Blood Pressure Monitors; C-reactive protein; Calcium; Cardiac; Cardiovascular Diseases; Cardiovascular system; Cause of Death; Center for Translational Science Activities; Cessation of life; Classification; Clinic; Clinical; Clinical and Translational Science Awards; Coronary artery; Coronary heart disease; Data; Detection; Diabetes Mellitus; Diagnosis; Epidemiology; Event; Glucose; Goals; Health; Heart Diseases; High Prevalence; Home Blood Pressure Monitoring; Home environment; Hour; Hyperlipidemia; Hypertension; Investigation; Lead; Left Ventricular Hypertrophy; Left Ventricular Mass; Light; Lipids; Measurement; Measures; Monitor; Morbidity - disease rate; North Carolina; Occupations; Organ; Outcome; Patients; Persons; Population; Population Attributable Risks; Population Control; Populations at Risk; Prevalence; Primary Health Care; Procedures; Protocols documentation; Public Health; Recommendation; Recruitment Activity; Reproducibility; Research; Research Design; Research Personnel; Resources; Retrospective Studies; Risk; Risk Assessment; Risk Factors; Sampling; Screening procedure; Serum; Site; Smoker; Smoking; Son; Staging; Stratification; Stress; Stroke; Study Subject; Testing; Translating; Treatment/Psychosocial Effects; United States; Universities; Urine; base; blood pressure regulation; cardiovascular disorder risk; coronary artery calcification; effective therapy; experience; heart disease risk; hypertension treatment; imaging modality; improved; indexing; masked hypertension; mortality; novel; psychosocial; public health relevance; socioeconomics; tool; trait

DESCRIPTION (provided by applicant): Reproducibility and Clinical Implications of Masked Hypertension Hypertension-the most important cardiovascular disease (CVD) risk factor-can go undetected for one of two main reasons: either a person's blood pressure (BP) is simply not checked (i.e., the person is not screened), or the screening measurement itself does not detect it. Over the past four decades, much effort has been devoted to improving screening rates for detection of high BP. Only recently, however, through the use of 24-hour ambulatory BP monitoring (ABPM), has attention been given to the possibility that "false negative" office BP measurements may be substantial in number and clinically important. Masked hypertension (MH) denotes BP that is not elevated (<140/90 mm Hg) when measured in the office, but elevated when repeated measurements are averaged over the course of a day. The prevalence of MH in the general adult population is estimated to be 10%. Recent data suggest that people with MH have cardiovascular target organ damage and an increase in CVD events of an order of magnitude approaching that seen in people with sustained hypertension (elevated office BP levels with elevated out-of-office BP levels). Many important unresolved questions need to be answered, however, before clinical recommendations can be made. Chief among these is whether MH represents a reproducible phenomenon. Another important consideration is clarifying whether home BP monitoring (HBPM) can be used in place of ABPM to identify MH, and if so, whether it serves to identify the same at-risk population. We aim to (1) assess the reproducibility of MH and evaluate the agreement between HBPM and ABPM in identifying MH, (2) identify demographic, psychosocial, and clinical factors associated with MH, and (3) explore the degree of target organ damage and subclinical atherosclerosis associated with MH. To accomplish these aims, we will perform two sets of office, ABPM, and HBPM BP measurements one week apart on 420 adults not under treatment for hypertension recruited from twelve primary care practices. Other measures will include serum glucose, lipids, and C-reactive protein; urine albumin; left ventricular mass index; coronary artery calcium; perceived stress; job and home strain; and trait-anger. The research team has extensive experience with BP measurement research, psychosocial effects on BP, cardiac imaging methods, coronary heart disease risk assessment, and conducting research in networks of primary care practices. Our study is expected to improve our understanding of the epidemiology and implications of MH and ultimately lead to strategies that will improve detection of high BP in the population. PUBLIC HEALTH RELEVANCE: The possibility that office blood pressure measurements fail to detect hypertension for millions of people demands the kind of rigorous investigations described in the proposed study. The findings are expected to lead to clinical strategies enabling greater recognition of hypertension, and therefore, ultimately to a reduction in cardiovascular morbidity and mortality in the population.

描述（由申请人提供）：隐性高血压的生殖和临床意义高血压-最重要的心血管疾病（CVD）风险因素-可能由于两个主要原因之一而未被发现：要么一个人的血压（BP）根本没有检查（即，在过去的四十年里，人们一直致力于提高高血压检测的筛查率。然而，直到最近，通过24小时动态血压监测（ABPM）的使用，人们才注意到“假阴性”办公室血压测量可能在数量上很大且具有临床重要性。隐性高血压（MH）是指在办公室测量时血压不升高（<140/90 mm Hg），但在一天内重复测量时平均血压升高。一般成人人群中MH的患病率估计为10%。最近的数据表明，患有MH的人有心血管靶器官损伤，并且CVD事件的数量级增加接近持续性高血压患者（办公室BP水平升高，办公室外BP水平升高）。然而，在提出临床建议之前，需要回答许多重要的未解决的问题。其中最主要的是MH是否代表一种可重复的现象。另一个重要的考虑因素是澄清家庭BP监测（HBPM）是否可以用来代替ABPM来识别MH，如果可以，它是否可以识别相同的高危人群。我们的目的是（1）评估MH的可重复性，并评估HBPM和ABPM在识别MH方面的一致性，（2）确定与MH相关的人口统计学，心理社会学和临床因素，（3）探索与MH相关的靶器官损伤和亚临床动脉粥样硬化的程度。为了实现这些目标，我们将进行两套办公室，ABPM和HBPM血压测量一周内从12个初级保健的做法招募420名成年人没有接受治疗的高血压。其他测量指标包括血糖、血脂和C反应蛋白;尿白蛋白;左心室质量指数;冠状动脉钙;感知压力;工作和家庭压力;和特质愤怒。该研究团队在BP测量研究、对BP的心理社会影响、心脏成像方法、冠心病风险评估以及在初级保健实践网络中进行研究方面拥有丰富的经验。我们的研究有望提高我们对MH流行病学和影响的理解，并最终导致改善人群中高血压检测的策略。 公共卫生相关性：办公室血压测量无法检测数百万人的高血压的可能性需要在拟议的研究中描述的那种严格的调查。这些发现有望导致临床策略，使更多的认识高血压，因此，最终降低心血管疾病的发病率和死亡率的人口。