非裔美国人基于人群样本中隐匿性高血压的患病率、决定因素及临床意义：杰克逊心脏研究
Prevalence, Determinants, and Clinical Significance of Masked Hypertension in a Population-Based Sample of African Americans: The Jackson Heart Study.
作者信息
Diaz Keith M, Veerabhadrappa Praveen, Brown Michael D, Whited Matthew C, Dubbert Patricia M, Hickson DeMarc A
机构信息
Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, New York, USA;
Department of Exercise Science, Shippensburg University, Shippensburg, Pennsylvania, USA;
出版信息
Am J Hypertens. 2015 Jul;28(7):900-8. doi: 10.1093/ajh/hpu241. Epub 2014 Dec 12.
BACKGROUND
The disproportionate rates of cardiovascular disease in African Americans may, in part, be due to suboptimal assessment of blood pressure (BP) with clinic BP measurements alone. To date, however, the prevalence of masked hypertension in African Americans has not been fully delineated. The purpose of this study was to evaluate masked hypertension prevalence in a large population-based sample of African Americans and examine its determinants and association with indices of target organ damage (TOD).
METHODS
Clinic and 24-hour ambulatory BP monitoring were conducted in 972 African Americans enrolled in the Jackson Heart Study. Common carotid artery intima-media thickness, left ventricular mass index, and the urinary albumin:creatinine excretion ratio were evaluated as indices of TOD.
RESULTS
Masked hypertension prevalence was 25.9% in the overall sample and 34.4% in participants with normal clinic BP. All indices of TOD were significantly higher in masked hypertensives compared to sustained normotensives and were similar between masked hypertensives and sustained hypertensives. Male gender, smoking, diabetes, and antihypertensive medication use were independent determinants of masked hypertension in multivariate analyses.
CONCLUSIONS
In this population-based cohort of African Americans, approximately one-third of participants with presumably normal clinic BP had masked hypertension when BP was assessed in their daily environment. Masked hypertension was accompanied by a greater degree of TOD in this cohort.
背景
非裔美国人中心血管疾病发病率不成比例，部分原因可能是仅通过诊所血压测量对血压（BP）的评估不够理想。然而，迄今为止，非裔美国人中隐匿性高血压的患病率尚未完全明确。本研究的目的是评估一大群非裔美国人中隐匿性高血压的患病率，并研究其决定因素以及与靶器官损害（TOD）指标的关联。
方法
对参加杰克逊心脏研究的972名非裔美国人进行了诊所血压测量和24小时动态血压监测。评估了颈总动脉内膜中层厚度、左心室质量指数和尿白蛋白：肌酐排泄率作为TOD指标。
结果
总体样本中隐匿性高血压患病率为25.9%，诊所血压正常的参与者中患病率为34.4%。与持续性血压正常者相比，隐匿性高血压患者的所有TOD指标均显著更高，隐匿性高血压患者与持续性高血压患者之间的指标相似。在多变量分析中，男性、吸烟、糖尿病和使用抗高血压药物是隐匿性高血压的独立决定因素。
结论
在这个以人群为基础的非裔美国人队列中，当在日常环境中评估血压时，大约三分之一诊所血压可能正常的参与者患有隐匿性高血压。在这个队列中，隐匿性高血压伴随着更高程度的TOD。
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