Lurbe Empar, Torro Isabel, Alvarez Vicente, Nawrot Tim, Paya Rafael, Redon Josep, Staessen Jan A
Pediatric Nephrology Unit, Hospital General Universitari, Avenida Tres Cruces 2, Valencia 46014, Spain.
Hypertension. 2005 Apr;45(4):493-8. doi: 10.1161/01.HYP.0000160320.39303.ab. Epub 2005 Mar 14.
Masked hypertension, an elevated daytime ambulatory blood pressure in the presence of a normal office blood pressure, confers an increased cardiovascular risk to adults. We investigated the prevalence, persistence, and clinical significance of masked hypertension in children and adolescents. We enrolled 592 youths (6 to 18 years old). Youths with masked hypertension (n=34) and a random sample of the normotensive participants (n=200) were followed-up. In a nested case-control study, we compared echocardiographic left ventricular mass among cases with persistent masked hypertension and normotensive controls. At baseline, mean age was 10.2 years; 535 youths were normotensive on office and daytime ambulatory blood pressure measurement (90.4%), and 45 had masked hypertension (7.6%). Compared with normotensive controls, participants with masked hypertension had a higher ambulatory pulse rate, were more obese, and were 2.5-times more likely to have a parental history of hypertension. Among 34 patients with masked hypertension (median follow-up 37 months), 18 became normotensive, 13 had persistent masked hypertension, and 3 had sustained hypertension. Patients with persistent masked hypertension (n=17) or who progressed from masked to sustained hypertension (n=3) had a higher left ventricular mass index (34.9 versus 29.6 g/m2.7; P=0.023) and a higher percentage with left ventricular mass index above the 95th percentile (30% versus 0%; P=0.014) than normotensive controls. In children and adolescents, masked hypertension is a precursor of sustained hypertension and left ventricular hypertrophy. This condition warrants follow-up and, once it becomes persistent, is an indication for blood pressure-lowering treatment.
隐匿性高血压是指诊室血压正常但日间动态血压升高，它会增加成年人患心血管疾病的风险。我们调查了儿童和青少年隐匿性高血压的患病率、持续性及临床意义。我们招募了592名青少年（6至18岁）。对隐匿性高血压患者（n = 34）和血压正常参与者的随机样本（n = 200）进行了随访。在一项巢式病例对照研究中，我们比较了持续性隐匿性高血压患者与血压正常对照组的超声心动图左心室质量。基线时，平均年龄为10.2岁；535名青少年诊室血压和日间动态血压测量均正常（90.4%），45名有隐匿性高血压（7.6%）。与血压正常对照组相比，隐匿性高血压参与者的动态脉搏率更高，更肥胖，有高血压家族史的可能性是对照组的2.5倍。在34例隐匿性高血压患者中（中位随访37个月），18例血压恢复正常，13例仍有持续性隐匿性高血压，3例发展为持续性高血压。持续性隐匿性高血压患者（n = 17）或从隐匿性高血压进展为持续性高血压的患者（n = 3）的左心室质量指数更高（34.9对29.6 g/m2.7；P = 0.023），左心室质量指数高于第95百分位数的百分比也更高（30%对零；P = 0.014）。在儿童和青少年中，隐匿性高血压是持续性高血压和左心室肥厚的先兆。这种情况需要随访，一旦持续存在，就是进行降压治疗的指征。
