Improving the Detection of Masked Hypertension: Analysis of Pooled Population- and Community-Based Studies

项目总结/摘要 基于在诊所中获得的测量值的血压（BP）通常不能准确地反映一个人的血压。 血压超出临床范围。隐匿性高血压是指血压水平不在高血压范围内， 在诊所内测量，但在诊所外测量时在高血压范围内。以前的研究， 主要来自欧洲和亚洲，报告了隐性高血压是常见的，并与两个- 与非高血压BP相比，在以下两种情况下，心血管疾病（CVD）的风险增加一倍 诊所2017年美国心脏病学会（ACC）/美国心脏协会（AHA）BP指南 建议筛查隐性高血压，以指导开始和加强抗高血压治疗 药动态血压监测（ABPM），外部测量血压的参考标准 在临床环境中，测量血压超过24小时，包括当一个人醒着和睡着了。 然而，2017年ACC/AHA BP指南建议仅使用清醒BP，而不是睡眠或24小时BP 本指南中定义隐匿性高血压的BP阈值较低 与之前的定义相比。我们建议：（1）确定使用清醒，睡眠和24小时BP的影响 与单独清醒BP相比， 蛋白尿;（2）确定2017年ACC/AHA BP指南定义对 隐性高血压与亚临床CVD和蛋白尿的相关性;（3）预测 模型来确定哪些人应该接受隐性高血压筛查。我们将在以下方面实现这些目标： 分别服用和不服用抗高血压药物的参与者，以及非西班牙裔白人，非西班牙裔白人， 西班牙裔黑人和西班牙裔。为了实现这些目标，我们将汇集以前从5个NHLBI收集的数据- 受资助的基于人群和社区的研究：杰克逊心脏研究，冠状动脉风险 在年轻人中开展的研究、隐蔽性高血压研究、 高血压研究和北卡罗来纳州隐蔽高血压研究。这些研究包括非西班牙裔 白人（n= 1，202）、非西班牙裔非裔美国人（n= 1，612）、西班牙裔（n=359）和其他人种/种族 组（n=126）在诊所和ABPM测量血压;完成超声心动图和 白蛋白尿评估;并有广泛的协变量数据进行分析。在3，299名参与者中（> 2，800人， 门诊收缩压<140毫米汞柱和<90毫米汞柱），我们计划纳入我们的分析，平均年龄为48岁[95% 置信区间：43 - 53岁]，62%为女性，74%未服用抗高血压药 药这项研究可能会导致更新的指南建议，以定义隐性高血压 以及一个算法来确定谁应该接受ABPM来筛查隐性高血压。发现还可以 改善对BP相关CVD风险评估，并识别将从治疗中受益的成年人。

PROJECT SUMMARY/ABSTRACT Blood pressure (BP) based on measurements obtained in the clinic often does not accurately reflect a person’s BP outside of the clinic setting. Masked hypertension refers to BP levels not in the hypertensive range when measured in the clinic but in the hypertensive range when measured outside of the clinic. Previous studies, primarily from Europe and Asia, have reported masked hypertension to be common and associated with a two- times greater risk of cardiovascular disease (CVD) compared with non-hypertensive BP both in and outside of the clinic. The 2017 American College of Cardiology (ACC) / American Heart Association (AHA) BP guideline recommends screening for masked hypertension to guide the initiation and intensification of antihypertensive medication. Ambulatory blood pressure monitoring (ABPM), the reference standard for measuring BP outside of the clinic setting, measures BP over a 24-hour period including while a person is awake and asleep. However, the 2017 ACC/AHA BP guideline recommends only to use awake BP and not asleep or 24-hour BP to define masked hypertension, and BP thresholds for defining masked hypertension are lower in this guideline compared to prior definitions. We propose to: (1) determine the impact of using awake, asleep, and 24-hour BP versus awake BP alone on the prevalence of masked hypertension and associations with sub-clinical CVD and albuminuria; (2) determine the impact of the 2017 ACC/AHA BP guideline definition on the prevalence of masked hypertension and associations with sub-clinical CVD and albuminuria; and (3) develop a prediction model to identify who should be screened for masked hypertension. We will address these aims among participants taking and not taking antihypertensive medication, separately, and for non-Hispanic whites, non- Hispanic blacks and Hispanics. To address these aims, we will pool previously collected data from 5 NHLBI- funded population- and community-based studies: the Jackson Heart Study, the Coronary Artery Risk Development in Young Adults Study, the Masked Hypertension Study, the Improving the Detection of Hypertension Study, and the North Carolina Masked Hypertension Study. These studies include non-Hispanic whites (n=1,202), non-Hispanic African Americans (n=1,612), Hispanics (n=359), and other race/ethnicity groups (n=126) who had their BP measured in the clinic and by ABPM; completed an echocardiogram and an albuminuria assessment; and have extensive covariate data for analysis. Of the 3,299 participants (>2,800 with clinic SBP<140 mm Hg and <90 mm Hg) we plan to include in our analyses, the mean age was 48 [95% confidence interval: 43 to 53 years of age] years, 62% were female, and 74% were not taking antihypertensive medication. This research could lead to updated guideline recommendations to define masked hypertension and an algorithm to identify who should undergo ABPM to screen for masked hypertension. Findings could also improve assessment of BP-related CVD risk and identify adults who would benefit from treatment.