Matsui Yoshio, Eguchi Kazuo, Ishikawa Joji, Hoshide Satoshi, Shimada Kazuyuki, Kario Kazuomi
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
Am J Hypertens. 2007 Apr;20(4):385-91. doi: 10.1016/j.amjhyper.2006.10.008.
Masked hypertension (MHT: normal office blood pressure [BP] + elevated BP out of the office) is a significant predictor of target organ damage and cardiovascular disease. The purpose of this study was to investigate the subclinical arterial damage in unmedicated subjects with MHT detected by home BP measurement.
We recruited 282 subjects not taking antihypertensive medication, who had at least one of the following five cardiovascular risk factors: high BP, hyperlipidemia, diabetes mellitus, current smoking, and chronic kidney disease. Furthermore, we classified them into four groups (normotension [NT], white-coat hypertension [WCHT], MHT, and sustained hypertension [SHT]) by office BP (140/90 mm Hg) and home BP (135/85 mm Hg) measurements. Arterial damage was evaluated by measuring carotid intima-media thickness (IMT) and brachial-ankle pulse wave velocity (baPWV).
Subjects with MHT had a higher prevalence of habitual alcohol drinkers than the other groups, and higher pulse rates at home than those with NT and WCHT. After adjustment for covariates, carotid IMT was the highest in MHT among the four groups (mean: 1.01 v 0.83 mm for NT, 0.86 mm for WCHT, and 0.91 mm for SHT, all P < .01). The baPWV was also significantly higher in MHT than NT and WCHT (mean: 1940 v 1663 and 1733 cm/sec, all P < .01), whereas the difference between MHT and SHT (2023 cm/sec) was not significant.
This study shows that masked hypertensives detected by home BP are at higher risk for increased arterial damage than normotensives or white-coat hypertensives, and potentially than sustained hypertensives.
隐匿性高血压（MHT：诊室血压正常 + 诊室外血压升高）是靶器官损害和心血管疾病的重要预测指标。本研究的目的是调查通过家庭血压测量检测出的未用药MHT受试者的亚临床动脉损害情况。
我们招募了282名未服用抗高血压药物的受试者，他们至少具有以下五种心血管危险因素之一：高血压、高脂血症、糖尿病、当前吸烟和慢性肾病。此外，我们通过诊室血压（140/90 mmHg）和家庭血压（135/85 mmHg）测量将他们分为四组（正常血压[NT]、白大衣高血压[WCHT]、MHT和持续性高血压[SHT]）。通过测量颈动脉内膜中层厚度（IMT）和臂踝脉搏波速度（baPWV）评估动脉损害情况。
MHT受试者中习惯性饮酒者的患病率高于其他组，且在家中的脉搏率高于NT组和WCHT组。在对协变量进行调整后，四组中MHT的颈动脉IMT最高（平均值：NT组为1.01 vs 0.83 mm，WCHT组为0.86 mm，SHT组为0.91 mm，所有P < .01）。MHT的baPWV也显著高于NT组和WCHT组（平均值：1940 vs 1663和1733 cm/秒，所有P < .01），而MHT与SHT之间的差异（2023 cm/秒）不显著。
本研究表明，通过家庭血压检测出的隐匿性高血压患者比正常血压者或白大衣高血压患者，可能也比持续性高血压患者，发生动脉损害增加的风险更高。
