Leiria Liana F, Severo Mateus D, Ledur Priscila S, Becker Alexandre D, Aguiar Fernanda M, Massierer Daniela, Freitas Valéria C, Schaan Beatriz D, Gus Miguel
Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
J Diabetes. 2015 Sep;7(5):699-707. doi: 10.1111/1753-0407.12231. Epub 2015 Apr 9.
The association between hypertensive phenotypes of controlled hypertension (CH), white-coat effect (WCE), masked uncontrolled hypertension (MUH) and sustained hypertension (SH) with target organ damage have not been clearly established in diabetic hypertensive treated patients. The present study aims to evaluate the prevalence of the four phenotypes considering the current cut-off points for office and 24 h-ambulatory blood pressure monitoring (ABPM) and the association with left ventricle hypertrophy (LVH), diastolic function and nephropathy.
Cross-sectional study with 304 patients on anti-hypertensive treatment aged 57.6 ± 6.1 years, who were submitted to ABPM and echocardiography. They were classified into CH (normal office BP and ABPM), WCE (high office BP and normal ABPM), MUH (normal office BP and high ABPM), and SH (high office BP and ABPM).
Median HbA1c and diabetes duration were 7.9% (6.8-9.2), and 10 years (5-16), respectively. Prevalences of CH, WCE, MUH and SH were 27.3%, 17.1%, 18.8%, and 36.8%. MUH prevalence was higher than previously described. There was a significant increasing trend across the four groups in variables related to LVH (P < 0.001 for trend). There was not a clear "dose-response" relationship of the four hypertensive phenotypes with nephropathy and diastolic function.
The use of ABPM beyond the traditional cardiovascular risk stratification tools has limitations, but is still useful in high-risk patients. Longitudinal studies could better evaluate the role of the use of ABPM in this scenario. Cut-off points for normality of office and ABPM influence the prevalences of WCH and MUH.
在接受治疗的糖尿病高血压患者中，血压控制正常的高血压（CH）、白大衣效应（WCE）、隐匿性未控制高血压（MUH）和持续性高血压（SH）这几种高血压表型与靶器官损害之间的关联尚未明确确立。本研究旨在根据目前用于诊室血压和24小时动态血压监测（ABPM）的切点，评估这四种表型的患病率以及与左心室肥厚（LVH）、舒张功能和肾病的关联。
对304例年龄为57.6±6.1岁的接受抗高血压治疗的患者进行横断面研究，这些患者接受了ABPM和超声心动图检查。他们被分为CH组（诊室血压和ABPM正常）、WCE组（诊室血压高而ABPM正常）、MUH组（诊室血压正常而ABPM高）和SH组（诊室血压和ABPM高）。
糖化血红蛋白（HbA1c）中位数和糖尿病病程分别为7.9%（6.8 - 9.2）和10年（5 - 16）。CH、WCE、MUH和SH的患病率分别为27.3%、17.1%、18.8%和36.8%。MUH的患病率高于先前报道。与LVH相关的变量在这四组中呈显著增加趋势（趋势P<0.001）。这四种高血压表型与肾病和舒张功能之间没有明确的“剂量反应”关系。
在传统心血管风险分层工具之外使用ABPM存在局限性，但在高危患者中仍有用处。纵向研究可以更好地评估在这种情况下使用ABPM的作用。诊室血压和ABPM正常的切点会影响白大衣高血压（WCH）和MUH的患病率。
