Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ - CIBER in Epidemiology and Public Health (CIBERESP), AvdaArzobispoMorcillo 2, 28029 Madrid, Spain
Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ - CIBER in Epidemiology and Public Health (CIBERESP), AvdaArzobispoMorcillo 2, 28029 Madrid, Spain Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain.
Eur Heart J. 2014 Dec 7;35(46):3304-12. doi: 10.1093/eurheartj/ehu016. Epub 2014 Feb 3.
There are limited data on the quality of treated blood pressure (BP) control during normal daily life, and in particular, the prevalence of 'masked uncontrolled hypertension' (MUCH) in people with treated and seemingly well-controlled BP is unknown. This is important because masked hypertension in 'treatment naïve' patients is associated with a high risk of cardiovascular events. We therefore conducted the first study to define the prevalence and characteristics of MUCH among a large sample of hypertensive patients in routine clinical practice in whom BP was treated and controlled to recommended clinic BP goals.
We analysed data from the Spanish Society of Hypertension ambulatory blood pressure monitoring (ABPM) Registry and identified patients with treated and controlled BP according to current international guidelines (clinic BP <140/90 mmHg). Masked uncontrolled hypertension was diagnosed in these patients if despite controlled clinic BP, the mean 24-h ABPM average remained elevated (24-h systolic BP ≥130 mmHg and/or 24-h diastolic BP ≥80 mmHg). From 62 788 patients with treated BP in the Spanish registry, we identified 14 840 with treated and controlled clinic BP, of whom 4608 patients (31.1%) had MUCH according to 24-h ABPM criteria (mean age 59.4 years, 59.7% men). The prevalence of MUCH was significantly higher in males, patients with borderline clinic BP (130-9/80-9 mmHg), and patients at high cardiovascular risk (smokers, diabetes, obesity). Masked uncontrolled hypertension was most often because of poor control of nocturnal BP, with the proportion of patients in whom MUCH was solely attributable to an elevated nocturnal BP almost double that solely attributable to daytime BP elevation (24.3 vs. 12.9%, P < 0.001).
The prevalence of masked suboptimal BP control in patients with treated and well-controlled clinic BP is high. Clinic BP monitoring alone is thus inadequate to optimize BP control because many patients have an elevated nocturnal BP. These findings suggest that ABPM should become more routine to confirm BP control, especially in higher risk groups and/or those with borderline control of clinic BP.
关于正常日常生活中治疗后血压（BP）控制的质量，数据有限，特别是在治疗后血压看似得到良好控制的人群中，“未识别的未控制高血压”（MUCH）的患病率尚不清楚。这一点很重要，因为在“治疗初治”患者中，隐匿性高血压与心血管事件的高风险相关。因此，我们进行了第一项研究，以确定在常规临床实践中接受治疗且血压控制达到推荐诊室 BP 目标的大量高血压患者中 MUCH 的患病率和特征。
我们分析了西班牙高血压学会动态血压监测（ABPM）登记处的数据，并根据当前国际指南（诊室 BP <140/90 mmHg）确定了治疗且血压得到控制的患者。如果尽管诊室 BP 得到控制，但平均 24 小时 ABPM 平均值仍升高（24 小时收缩压≥130 mmHg 和/或 24 小时舒张压≥80 mmHg），则诊断为隐匿性未控制高血压。在西班牙登记处的 62788 名治疗性 BP 患者中，我们确定了 14840 名治疗且诊室 BP 得到控制的患者，其中根据 24 小时 ABPM 标准，4608 名患者（31.1%）患有 MUCH（平均年龄 59.4 岁，59.7%为男性）。 MUCH 的患病率在男性、处于诊室 BP 临界值（130-9/80-9mmHg）的患者和心血管风险较高的患者（吸烟者、糖尿病患者、肥胖者）中显著更高。隐匿性未控制高血压主要是由于夜间 BP 控制不佳所致，其中 MUCH 仅归因于夜间 BP 升高的患者比例几乎是仅归因于白天 BP 升高的患者比例的两倍（24.3%比 12.9%，P<0.001）。
在治疗且诊室 BP 得到良好控制的患者中，隐匿性 BP 控制不佳的患病率很高。因此，仅诊室 BP 监测不足以优化 BP 控制，因为许多患者的夜间 BP 升高。这些发现表明，ABPM 应该更常规地用于确认 BP 控制，尤其是在高风险人群和/或诊室 BP 控制临界值的患者中。
