Ishikawa Joji, Kario Kazuomi, Eguchi Kazuo, Morinari Masato, Hoshide Satoshi, Ishikawa Shizukiyo, Shimada Kazuyuki
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medial University School of Medicine, Shimotsuke, Japan.
Hypertens Res. 2006 Sep;29(9):679-86. doi: 10.1291/hypres.29.679.
Morning blood pressure (BP) level may play an important role in the pathogenesis of cardiovascular events; however, morning BP detected by home BP monitoring may remain uncontrolled in medicated hypertensive patients even when clinic BP is well controlled (masked morning hypertension: MMHT). We studied the determinants of MMHT in stably medicated hypertensive outpatients. In the Jichi Morning Hypertension Research (J-MORE) study, 969 consecutive hypertensive outpatients were recruited by 43 doctors in 32 different institutes. They had been under stable antihypertensive medication status at least for 3 months. Clinic BP was measured on 2 different days and self-measured BP monitoring was conducted twice consecutively in the morning and evening for 3 days. Four-hundred and five patients had well-controlled clinic BP (systolic BP [SBP]<140 mmHg and diastolic BP [DBP]<90 mmHg). Among them, 246 patients (60.7%) had MMHT (morning SBP > or =135 mmHg and/or DBP > or =85 mmHg). Compared with the patients with normal clinic BP and morning BP, the patients with MMHT had a significantly higher prevalence of regular alcohol drinkers (35.0% vs. 23.3%, p=0.012), a significantly higher number of antihypertensive drug classes (1.83 +/- 0.82 vs. 1.66 +/- 0.84, p = 0.04) and a significantly higher clinic BP level (SBP: 130.4 +/- 7.6 mmHg vs. 127.8 +/- 8.4 mmHg, p = 0.001; DBP: 75.5 +/- 7.6 mmHg vs. 73.6 +/- 7.6 mmHg, p = 0.013). In logistic regression analysis, independent determinants for MMHT were regular alcohol drinking (odds ratio [OR]: 1.76; 95% confidence interval [CI]: 0.99-3.12; p = 0.05) and higher-normal clinic BP (130/85 mmHg < clinic SBP/DBP < 140/90 mmHg) (OR: 1.60; 95% CI: 1.05-2.44; p = 0.03) after adjustment for confounding factors. The patients who both drank alcohol regularly and had a higher-normal clinic BP had 2.71 times higher risk for MMHT than those who did not drink alcohol regularly and had a relatively lower-normal clinic BP (<130/85 mmHg) (p < 0.01). In conclusion, regular alcohol drinking is an independent determinant for MMHT detected by home BP monitoring in medicated hypertensive patients with well-controlled clinic BP.
清晨血压水平可能在心血管事件的发病机制中起重要作用；然而，即使诊室血压得到良好控制，通过家庭血压监测检测到的清晨血压在接受药物治疗的高血压患者中仍可能未得到控制（隐匿性清晨高血压：MMHT）。我们研究了稳定接受药物治疗的高血压门诊患者中MMHT的决定因素。在秩父清晨高血压研究（J-MORE）中，32个不同机构的43名医生招募了969名连续的高血压门诊患者。他们至少已处于稳定的降压治疗状态3个月。在2个不同的日子测量诊室血压，并在早晨和晚上连续3天进行自我血压监测。405例患者的诊室血压得到良好控制（收缩压[SBP]<140 mmHg且舒张压[DBP]<90 mmHg）。其中，246例患者（60.7%）患有MMHT（清晨SBP≥135 mmHg和/或DBP≥85 mmHg）。与诊室血压和清晨血压正常的患者相比，MMHT患者中经常饮酒者的患病率显著更高（35.0%对23.3%，p=0.012），使用的降压药物种类显著更多（1.83±0.82对1.66±0.84，p = 0.04），且诊室血压水平显著更高（SBP：130.4±7.6 mmHg对127.8±8.4 mmHg，p = 0.001；DBP：75.5±7.6 mmHg对73.6±7.6 mmHg，p = 0.013）。在逻辑回归分析中，在调整混杂因素后，MMHT的独立决定因素是经常饮酒（优势比[OR]：1.76；95%置信区间[CI]：0.99 - 3.12；p = 0.05）和较高的正常诊室血压（130/85 mmHg<诊室SBP/DBP<140/90 mmHg）（OR：1.60；95%CI：1.05 - 2.44；p = 0.03）。既经常饮酒又有较高正常诊室血压的患者发生MMHT的风险是那些不经常饮酒且诊室血压相对较低（<130/85 mmHg）的患者的2.71倍（p<0.01）。总之，对于诊室血压得到良好控制的接受药物治疗的高血压患者，经常饮酒是通过家庭血压监测检测到的MMHT的独立决定因素。
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