Shimada Kazuyuki, Fujita Toshiro, Ito Sadayoshi, Naritomi Hiroaki, Ogihara Toshio, Shimamoto Kazuaki, Tanaka Heizo, Yoshiike Nobuo
Jichi Medical University School of Medicine, Shimotsuke, Japan.
Hypertens Res. 2008 Oct;31(10):1903-11. doi: 10.1291/hypres.31.1903.
White-coat hypertension (HT) and masked HT can be identified by home blood pressure (BP) measurement. The prevalence of these subtypes and the associated risk of cardiovascular disease have not been fully investigated among Japanese hypertensive patients. The risk of cardiovascular events due to HT and its relationship with home BP measurement were examined among Japanese hypertensive patients receiving treatment in the Japan Hypertension Evaluation with Angiotensin II Antagonist Losartan Therapy (J-HEALTH) study, a nationwide prospective observational study. Both home and clinic BP were measured during treatment, and the occurrence of cardiovascular events was monitored in 4,596 Japanese patients (mean age of 60.8 years, 43.2% men, and mean follow-up period of 3.5 years). HT was defined as a systolic BP > or =140 mmHg for clinic BP and > or =135 mmHg for home BP while on treatment. The relative risk of all cardiovascular events and stroke increased along with higher clinic and home BP levels during treatment. The prevalence of white-coat HT, masked HT, well-controlled HT, and poorly controlled HT was 12.6%, 19.5%, 23.8%, and 44.1%, respectively. The relative risk of cardiovascular events was not significantly increased in the poorly controlled HT (relative risk [RR]: 2.05, 95% confidence interval [CI]: 0.77-5.45), white-coat HT (RR: 0.77, 95% CI: 0.15-3.96), and masked HT (RR: 2.00, 95% CI: 0.67-5.98) subgroups compared with the well-controlled-HT subgroup; however, the risk of masked HT was similar to that of poorly controlled HT. Monitoring both clinic and home BP is important to diagnose masked HT and to prevent cardiovascular disease in this subtype of HT. However, further investigation is required to fully characterize the cardiovascular risks associated with masked HT among Japanese patients receiving treatment.
白大衣高血压（HT）和隐匿性HT可通过家庭血压（BP）测量来识别。在日本高血压患者中，这些亚型的患病率以及心血管疾病的相关风险尚未得到充分研究。在一项全国性前瞻性观察研究——日本高血压评估与血管紧张素II拮抗剂氯沙坦治疗（J-HEALTH）研究中，对接受治疗的日本高血压患者中HT导致心血管事件的风险及其与家庭血压测量的关系进行了检查。在治疗期间测量家庭和诊室血压，并对4596名日本患者（平均年龄60.8岁，男性占43.2%，平均随访期3.5年）的心血管事件发生情况进行监测。HT被定义为治疗期间诊室收缩压≥140 mmHg且家庭收缩压≥135 mmHg。治疗期间，所有心血管事件和中风的相对风险随着诊室和家庭血压水平的升高而增加。白大衣HT、隐匿性HT、血压控制良好的HT和血压控制不佳的HT的患病率分别为12.6%、19.5%、23.8%和44.1%。与血压控制良好的HT亚组相比，血压控制不佳的HT（相对风险[RR]：2.05，95%置信区间[CI]：0.77 - 5.45）、白大衣HT（RR：0.77，95% CI：0.15 - 3.96）和隐匿性HT（RR：2.00，95% CI：0.67 - 5.98）亚组的心血管事件相对风险没有显著增加；然而，隐匿性HT的风险与血压控制不佳的HT相似。监测诊室和家庭血压对于诊断隐匿性HT以及预防这种HT亚型的心血管疾病很重要。然而，需要进一步研究以全面描述接受治疗的日本患者中与隐匿性HT相关的心血管风险。
