Population Studies Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland.
J Hypertens. 2010 Apr;28(4):709-14. doi: 10.1097/HJH.0b013e3283369faa.
The best method to diagnose masked hypertension is controversial. The objective of the present study was to compare home blood pressure (HBP) and ambulatory blood pressure (ABP) measurement in the evaluation of masked hypertension.
Two hundred and sixty-one individuals from the general population underwent office BP (duplicate measurements on four visits), HBP (duplicate measurements on seven days) and 24-h ABP measurement, and risk factor evaluation. Target organ damage was assessed by echocardiography and 24-h urinary albumin measurement. Masked hypertension was defined as normal office BP (<140/90 mmHg) with elevated out-of-office BP (HBP >or=135/85 mmHg, daytime ABP >or=140/85 mmHg or both).
HBP and ABP detected 10.6 and 11.4% of masked hypertension, respectively. Only 59% of patients diagnosed as masked hypertensive with ABP measurement also had masked hypertension on HBP measurement. Masked hypertensive patients had higher BMI, waist-to-hip ratio and serum insulin levels than normotensive individuals. They also had greater waist-to-hip ratio than sustained hypertensive individuals. Target organ damage in masked hypertension was between that of normotension and that of sustained hypertension. Office normotensive individuals with elevated HBP tended to have higher rates of cardiovascular risk factors and target organ damage than patients with elevated ABP.
HBP and ABP detect a similar, but not an identical, group of masked hypertensive individuals. Their agreement in the diagnosis of masked hypertension is only moderate. Our results suggest that HBP measurement can be used to diagnose masked hypertension, but this diagnosis is not analogous with that made with ABP measurement.
目前对于隐匿性高血压的最佳诊断方法仍存在争议。本研究旨在比较家庭血压（HBP）和动态血压（ABP）在隐匿性高血压评估中的作用。
本研究纳入 261 名来自普通人群的个体，进行诊室血压（四次就诊时重复测量）、HBP（七天内重复测量）和 24 小时 ABP 测量，并进行危险因素评估。通过超声心动图和 24 小时尿白蛋白测量评估靶器官损伤。隐匿性高血压定义为诊室血压正常（<140/90mmHg）伴诊室外血压升高（HBP≥135/85mmHg、日间 ABP≥140/85mmHg 或两者兼有）。
HBP 和 ABP 分别检出 10.6%和 11.4%的隐匿性高血压患者。仅 59%的 ABP 测量诊断为隐匿性高血压的患者 HBP 测量也符合隐匿性高血压。与正常血压患者相比，隐匿性高血压患者的 BMI、腰臀比和血清胰岛素水平更高。与持续性高血压患者相比，隐匿性高血压患者的腰臀比也更大。隐匿性高血压患者的靶器官损伤介于正常血压和持续性高血压之间。诊室血压正常但 HBP 升高的患者发生心血管危险因素和靶器官损伤的比例高于 ABP 升高的患者。
HBP 和 ABP 检测到的隐匿性高血压患者相似，但不完全相同。它们在诊断隐匿性高血压时的一致性仅为中等水平。我们的结果表明，HBP 测量可用于诊断隐匿性高血压，但该诊断与 ABP 测量的诊断并不完全相同。
