Lehmann M V, Zeymer U, Dechend R, Kaiser E, Hagedorn I, Deeg E, Senges J, Schmieder R E
Department of Nephrology and Hypertension, University Hospital of Erlangen, Germany.
Int J Cardiol. 2013 Oct 3;168(3):2255-63. doi: 10.1016/j.ijcard.2013.01.209. Epub 2013 Mar 7.
Twenty-four hour ambulatory blood pressure (ABP) is superior to office blood pressure (BP) in predicting cardiovascular events. However, its use to optimise BP control in treated hypertensive patients is less well examined.
In this observational study conducted in 899 general practitioners' offices, 4078 hypertensive patients with uncontrolled office BP were included. Antihypertensive therapy was intensified and after 1 year office BP and 24-hour ABP were measured to categorise patients according to the ESC/ESH 2007 guidelines.
In this cohort (mean office BP 156/90 mmHg, mean ABP 146/85 mmHg), 2059 out of 4078 patients (50.5%) had controlled office BP (<140/90 mmHg) at 1 year examination. Of these apparently controlled patients (N=2059), 1339 (65.8%) had 24-hour ABP ≥ 130/80 mmHg, indicating masked hypertension (32.9% of all treated patients). In the prespecified subgroups the prevalence of masked hypertension was the following: diabetes 28.2%, CVD 29.1%, and CKD 32.1%. White coat hypertension (24h-ABP<130/80 mmHg and office BP ≥ 140/90 mmHg) was found in 12.4% (N=233) of patients with elevated office BP (6.1% of all treated patients), and in 5.7% of the diabetic subgroup, 5.6% CVD and 7.1% CKD. Discrepancies in BP categorisation between office BP and 24-hour ABP were high; all subjects 52.8%, diabetes 50.0%, CVD 49.0% and CKD 50.4%.
In hypertensive patients on therapy, 2 out of 3 with apparently controlled office BP had masked hypertension, suggesting a more aggressive therapy, and 1 out of 8 with elevated office BP had white coat hypertension potentially falsely forcing physicians to intensify therapy. The 3A Registry is listed under clinicaltrials.gov, NCT01454583.
在预测心血管事件方面，24小时动态血压（ABP）优于诊室血压（BP）。然而，其在优化已接受治疗的高血压患者血压控制方面的应用尚未得到充分研究。
在这项在899个全科医生办公室进行的观察性研究中，纳入了4078例诊室血压未得到控制的高血压患者。强化抗高血压治疗，1年后测量诊室血压和24小时ABP，根据欧洲心脏病学会/欧洲高血压学会（ESC/ESH）2007年指南对患者进行分类。
在该队列中（平均诊室血压156/90 mmHg，平均ABP 146/85 mmHg），4078例患者中有2059例（50.5%）在1年检查时诊室血压得到控制（<140/90 mmHg）。在这些看似血压得到控制的患者（N = 2059）中，1339例（65.8%）24小时ABP≥130/80 mmHg，表明存在隐匿性高血压（占所有接受治疗患者的32.9%）。在预先设定的亚组中，隐匿性高血压的患病率如下：糖尿病患者中为28.2%，心血管疾病（CVD）患者中为29.1%，慢性肾脏病（CKD）患者中为32.1%。白大衣高血压（24小时ABP<130/80 mmHg且诊室血压≥140/90 mmHg）在诊室血压升高的患者中占12.4%（N = 233）（占所有接受治疗患者的6.1%），在糖尿病亚组中占5.7%，CVD亚组中占5.6%，CKD亚组中占7.1%。诊室血压和24小时ABP之间的血压分类差异很大；所有受试者中为52.8%，糖尿病患者中为50.0%，CVD患者中为49.0%，CKD患者中为50.4%。
在接受治疗的高血压患者中，三分之二诊室血压看似得到控制的患者存在隐匿性高血压，这表明需要更积极的治疗，而八分之一诊室血压升高的患者存在白大衣高血压，这可能会错误地促使医生强化治疗。3A注册研究已在clinicaltrials.gov上注册，编号为NCT01454583。
