Department of Health Sciences, University of Milano-Bicocca, St Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy.
J Hypertens. 2013 Mar;31(3):616-23; discussion 623. doi: 10.1097/HJH.0b013e32835ca8bf.
The aim of this large-scale, practice-based observational study [Survey with HBPM and ABPM Under Real clinical conditions in General practice to Evaluate BP control in the early morning (SURGE)] was to ascertain the degree of morning and 24-h ambulatory blood pressure (ABP) control in hypertensive patients.
Hypertensive patients [with uncontrolled clinic blood pressure (BP) >140/90 mmHg at screening] from nine different countries were included. Ambulatory BP monitoring was performed over 24 h at 15-min intervals during the day and at 20-min intervals during the night. Assessments included morning (0600-1159 h) and daytime ABP control (BP < 135/85 mmHg), and 24-h ABP control, which was set at levels less than 125/80 mmHg (ESH/ESC guidelines) and less than 130/80 mmHg (USA guidelines).
A total of 3312 patients were enrolled [mean clinic BP: 153 ± 17/91 ± 10 mmHg; mean 24-h and morning ABP: 130 ± 15/77 ± 10 mmHg and 134 ± 16/80 ± 11 mmHg, respectively; antihypertensive use: 72.7% (n = 2409)]. Morning and daytime (period of activity) ABP control was observed in 45.2 and 47.4% of treated patients, respectively; 24-h ABP control was only achieved in 34.6% (ESH/ESC guidelines) and 44.7% (USA guidelines) of treated patients. There was 'poor agreement' between clinic BP and ABP regarding BP control as shown by a negative (≤0) κ coefficient in treated patients. Clinic BP control (<130/80 mmHg) and morning ABP control (<135/85 mmHg) was observed in 2.3 and 45.1% of diabetic patients, and in 2.4 and 43.6% of patients with left ventricular hypertrophy (LVH). Morning ABP control was 42.3% in patients with high/very high cardiovascular risk.
Clinic BP, morning and 24-h ABP control rates were low in treated hypertensive patients, including those with comorbidities, such as diabetes or LVH.
本大规模、基于实践的观察性研究[在一般实践中使用 HBPM 和 ABPM 进行调查以评估清晨血压控制（SURGE）]的目的是确定高血压患者清晨和 24 小时动态血压（ABP）控制的程度。
从九个不同国家纳入血压未得到控制的高血压患者[诊室血压（BP）>140/90mmHg 时筛查]。在白天每隔 15 分钟和夜间每隔 20 分钟进行 24 小时动态血压监测。评估包括清晨（0600-1159 小时）和白天 ABP 控制（BP<135/85mmHg），以及 24 小时 ABP 控制，设定为低于 125/80mmHg（ESH/ESC 指南）和低于 130/80mmHg（美国指南）。
共纳入 3312 例患者[平均诊室 BP：153±17/91±10mmHg；平均 24 小时和清晨 ABP：130±15/77±10mmHg 和 134±16/80±11mmHg；降压药物使用率：72.7%（n=2409）]。接受治疗的患者中，分别有 45.2%和 47.4%达到清晨和白天（活动期）ABP 控制；仅 34.6%（ESH/ESC 指南）和 44.7%（美国指南）的接受治疗患者达到 24 小时 ABP 控制。接受治疗的患者中，诊室 BP 与 ABP 之间的血压控制呈负相关（≤0），κ 系数为负值，表明两者之间存在“较差的一致性”。在糖尿病患者中，诊室 BP 控制（<130/80mmHg）和清晨 ABP 控制（<135/85mmHg）的发生率分别为 2.3%和 45.1%，左心室肥厚（LVH）患者的发生率分别为 2.4%和 43.6%。在心血管风险高/极高的患者中，清晨 ABP 控制率为 42.3%。
包括合并糖尿病或 LVH 等并发症的高血压患者在内，接受治疗的高血压患者的诊室 BP、清晨和 24 小时 ABP 控制率均较低。
