Department of Pediatrics, Consorcio Hospital General, University of Valencia, Avda Tres Cruces s/n, 46014 Valencia, Spain.
Hypertension. 2013 Aug;62(2):410-4. doi: 10.1161/HYPERTENSIONAHA.113.01549. Epub 2013 Jun 3.
The risk and factors related to the development of hypertension among healthy youths with elevated ambulatory and normal conventional blood pressure, masked hypertension, have not been established. We performed a long-term follow-up study assessing how hypertension develops over time in healthy, masked hypertensive youths. The potential sex dimorphism in the incidence and timing of the development of hypertension has been analyzed. In a long-term follow-up study (median follow-up, 36 months), we enrolled 272 healthy conventional normotensive youths (aged 6-18 years; 55.8% girls) of whom 39 had masked hypertension at baseline. Development of sustained hypertension (hypertension in both conventional and ambulatory measurement) was recorded. The daytime systolic blood pressure increased from baseline to last available follow-up in boys (3.5 mm Hg; P<0.001) but not in girls (0.7 mm Hg; P=0.23), leading to a significant between-sex difference (P=0.0022). The incidence of sustained hypertension was 7.0/100 subjects/y (n=12) in masked hypertensives and 0.6/100 subjects/y (n=4) in normotensives. Masked hypertensive boys more frequently proceeded to sustained hypertension as compared with masked hypertensive girls (50.0% versus 17.4%; P=0.041). Masked hypertension at baseline (hazard ratio, 15.6; 95% confidence interval, 4.91-49.7; P<0.0001) and male sex (hazard ratio, 3.25; 95% confidence interval, 1.12-9.39; P=0.0295) were independent factors associated with the incidence of sustained hypertension during the follow-up. In youth, masked hypertension is a precursor of sustained hypertension. The risk of developing sustained hypertension is higher in boys than it is for girls. The fact that masked hypertension is not prognostically innocent increases the importance of the diagnosis at an early age.
在静息和常规血压升高的健康青年中，尚未确定高血压发展的风险和相关因素，这些人表现为隐匿性高血压。我们进行了一项长期随访研究，以评估健康隐匿性高血压青年中高血压随时间的发展情况。分析了高血压发生和发展的潜在性别差异。在一项长期随访研究（中位随访 36 个月）中，我们招募了 272 名健康的常规血压正常的青年（年龄 6-18 岁；55.8%为女孩），其中 39 名基线时患有隐匿性高血压。记录持续性高血压（常规和动态血压测量均升高）的发生情况。男孩的日间收缩压从基线到最后一次可获得的随访时升高了 3.5mmHg（P<0.001），但女孩没有升高（0.7mmHg；P=0.23），导致男女之间存在显著差异（P=0.0022）。隐匿性高血压患者的持续性高血压发病率为 7.0/100 例/年（12 例），血压正常者为 0.6/100 例/年（4 例）。与隐匿性高血压女孩相比，隐匿性高血压男孩更常进展为持续性高血压（50.0%对 17.4%；P=0.041）。基线时的隐匿性高血压（危险比，15.6；95%置信区间，4.91-49.7；P<0.0001）和男性性别（危险比，3.25；95%置信区间，1.12-9.39；P=0.0295）是随访期间持续性高血压发生的独立相关因素。在青年中，隐匿性高血压是持续性高血压的前兆。与女孩相比，男孩发生持续性高血压的风险更高。隐匿性高血压并非预后无害的事实增加了早期诊断的重要性。
