Department of Internal Medicine, University Hospital Clementino Fraga Filho, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Hypertens Res. 2010 Aug;33(8):819-24. doi: 10.1038/hr.2010.80. Epub 2010 Jun 10.
Isolated office hypertension (IOH) has been associated with structural cardiac abnormalities; however, its relation to worse cardiovascular prognosis remains uncertain. Less is known regarding the consequences of uncontrolled IOH in treated hypertensives. The aim was to investigate whether uncontrolled IOH was independently associated with two subclinical markers of cardiovascular disease, aortic stiffness and left ventricular hypertrophy (LVH). Clinical laboratory and 24-h ambulatory blood pressure (BP) data were obtained in 523 hypertensive patients with type 2 diabetes. Controlled office-ambulatory hypertension was defined by office blood pressure <140/90 mm Hg and 24-h BP <130/80 mm Hg, whereas uncontrolled IOH by office blood pressure> or =140/90 mm Hg and 24-h BP <130/80 mm Hg. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (PWV) and left ventricular mass index (LVMI) by echocardiography. Statistics included multivariate linear and logistic regressions. According to BP patterns, 152 patients (29.1%) had controlled office-ambulatory hypertension, and 172 (32.9%) had uncontrolled IOH. Patients with uncontrolled IOH had greater LVMI (62.0+/-21.9 vs. 52.9+/-17.0 g m(-2.7), P<0.001) and PWV (11.5+/-2.4 vs. 10.2+/-2.1 m s(-1), P<0.001) than those with controlled hypertension. On linear model, after adjustment for several potential confounders, patients with uncontrolled IOH persisted with higher PWV (P=0.003) and LVMI (P=0.015). On logistic regression, the presence of uncontrolled IOH was independently associated with 2.7-fold (95% CI: 1.3-5.5) and 2.1-fold (95% CI: 1.1-4.0) higher risks of having increased aortic stiffness and LVH, respectively. In conclusion, uncontrolled IOH is associated with increased aortic stiffness and LVH in hypertensive type 2 diabetic patients. This may be a link to augmented cardiovascular risk.
孤立性诊室高血压（IOH）与结构性心脏异常有关；然而，其与心血管预后恶化的关系尚不确定。在接受治疗的高血压患者中，关于不受控制的 IOH 的后果知之甚少。目的是研究不受控制的 IOH 是否与心血管疾病的两个亚临床标志物（主动脉僵硬度和左心室肥厚（LVH））独立相关。在 523 名患有 2 型糖尿病的高血压患者中获得了临床实验室和 24 小时动态血压（BP）数据。通过诊室血压<140/90mmHg 和 24 小时 BP<130/80mmHg 定义控制良好的诊室-动态高血压，而通过诊室血压≥140/90mmHg 和 24 小时 BP<130/80mmHg 定义不受控制的 IOH。通过颈动脉-股动脉脉搏波速度（PWV）评估动脉僵硬度，通过超声心动图评估左心室质量指数（LVMI）。统计分析包括多元线性和逻辑回归。根据 BP 模式，152 名患者（29.1%）具有控制良好的诊室-动态高血压，172 名患者（32.9%）具有不受控制的 IOH。与控制良好的高血压患者相比，患有不受控制的 IOH 的患者具有更大的 LVMI（62.0+/-21.9 与 52.9+/-17.0 g m(-2.7)，P<0.001）和 PWV（11.5+/-2.4 与 10.2+/-2.1 m s(-1)，P<0.001）。在线性模型中，在校正了几个潜在的混杂因素后，患有不受控制的 IOH 的患者的 PWV 持续升高（P=0.003）和 LVMI（P=0.015）。在逻辑回归中，存在不受控制的 IOH 与主动脉僵硬度增加和 LVH 的风险分别增加 2.7 倍（95%CI：1.3-5.5）和 2.1 倍（95%CI：1.1-4.0）独立相关。总之，不受控制的 IOH 与高血压 2 型糖尿病患者的主动脉僵硬度和 LVH 增加有关。这可能是心血管风险增加的一个环节。
