Palatini Paolo
Department of Clinical and Experimental Medicine, University of Padova, Italy.
Blood Press Monit. 2004 Dec;9(6):297-9. doi: 10.1097/00126097-200412000-00005.
Recent evidence demonstrates that masked hypertension is a significant predictor of cardiovascular disease, but the problem for clinical practice is how to identify these patients. Furthermore, the prevalence of masked hypertension in the general population or in subjects with transient blood pressure elevation is still unknown. Data obtained in several cross-sectional studies have demonstrated large differences in the prevalence of masked hypertension, with prevalence rates from a low of 8% to a high of 49%. Two population-based studies performed in Italy and in Japan report prevalence of 9% and of 13.4%, respectively. A 49% frequency of masked hypertension has been found among subjects with transiently elevated clinic blood pressure. Several factors can selectively raise ambulatory blood pressure including age, sex, smoking, alcohol use, contraceptive use in women, and sedentary habits. Reactivity to daily life stressors and behavioural factors are other important determinants of ambulatory blood pressure. On the basis of the available evidence, masked hypertension should be searched for in individuals who are more likely to have this condition or are at increased risk of cardiovascular complications including diabetic individuals and subjects with kidney disease. Further research is needed to determine whether the use of ambulatory blood pressure monitoring is cost-effective in these subjects.
最近的证据表明，隐匿性高血压是心血管疾病的重要预测指标，但临床实践中的问题是如何识别这些患者。此外，普通人群或血压短暂升高的受试者中隐匿性高血压的患病率仍然未知。在几项横断面研究中获得的数据显示，隐匿性高血压的患病率存在很大差异，患病率从低至8%到高至49%不等。在意大利和日本进行的两项基于人群的研究报告的患病率分别为9%和13.4%。在诊所血压短暂升高的受试者中发现隐匿性高血压的发生率为49%。几个因素可选择性地升高动态血压，包括年龄、性别、吸烟、饮酒、女性使用避孕药以及久坐习惯。对日常生活应激源的反应性和行为因素是动态血压的其他重要决定因素。根据现有证据，应在更有可能患有这种疾病或心血管并发症风险增加的个体中寻找隐匿性高血压，包括糖尿病患者和肾病患者。需要进一步研究以确定在这些受试者中使用动态血压监测是否具有成本效益。
