Banegas José R, Ruilope Luis M, de la Sierra Alejandro, Vinyoles Ernest, Gorostidi Manuel, de la Cruz Juan J, Segura Julián, Oliveras Anna, Martell Nieves, García-Puig Juan, Williams Bryan
From the Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP), Spain (J.R.B., L.M.R., J.J.d.l.C.); Instituto de Investigación Hospital Doce de Octubre, Madrid, Spain (L.M.R.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); La Mina Primary Care Center, Department of Medicine, University of Barcelona, Spain (E.V.); Nephrology Service, Department of Medicine, Hospital Universitario Central de Asturias, RedinRed, Oviedo, Spain (M.G.); Hypertension Unit, Department of Nephrology, Hospital Doce de Octubre, Madrid, Spain (J.S.); Hypertension Unit, Department of Nephrology, Hospital Universitari del Mar and IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain (A.O.); Hypertension Unit, Department of Medicine, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del HCSC, Madrid, Spain (N.M.); Cardiometabolic and Hypertension Unit, Department of Medicine, Hospital Universitario La Paz, Universidad Autónoma de Madrid/IdiPAZ, Madrid, Spain (J.G.-P.); and University College London (UCL) Institute of Cardiovascular Science and NIHR UCL Hospitals Biomedical Research Centre, United Kingdom (B.W.).
Hypertension. 2017 Feb;69(2):211-219. doi: 10.1161/HYPERTENSIONAHA.116.08567. Epub 2016 Dec 27.
Clinic blood pressure (BP) is usually higher than daytime ambulatory BP in hypertensive patients, but some recent studies have challenged this view, suggesting that this relationship is strongly influenced by age. We used the Spanish ambulatory BP monitoring cohort to examine differences between clinic and daytime BP by age among 104 639 adult hypertensive patients (office systolic/diastolic BP ≥140/90 mm Hg or treated) in usual primary-care practice, across the wide age spectrum. To assess the impact of age, cardiovascular variables, and clinic BP on the clinic-daytime BP differences, we built multivariable regression models of the average BP differences, white-coat hypertension (high clinic BP and normal daytime BP), and masked hypertension (normal clinic BP and high daytime BP). In most patients, mean clinic BP values were higher than daytime BP at all ages. Some 36.7% of patients had white-coat hypertension (amounting to 50% at clinic systolic BP of 140-159 mm Hg) and 3.9% had masked hypertension (amounting to 18% at clinic systolic BP of 130-139 mm Hg). Age explained 0.1% to 1.7% of the variance of quantitative or categorical BP differences (P<0.001). Cardiovascular variables explained an additional 1.6% to 3.4% of the variance (P<0.001). Finally, clinic BP generally explained ≥20% more of the variance (P<0.01). In this large study in usual clinical practice, clinic BP misclassified hypertension status in >40% of patients. This misclassification was not importantly influenced by age but was more evident in patients with borderline/grade 1 hypertension. These findings reinforce the importance of ambulatory BP monitoring for defining BP status in routine clinical practice.
在高血压患者中，诊室血压通常高于日间动态血压，但最近一些研究对这一观点提出了质疑，表明这种关系受年龄的影响很大。我们利用西班牙动态血压监测队列，在广泛的年龄范围内，对104639名成年高血压患者（诊室收缩压/舒张压≥140/90 mmHg或正在接受治疗）在常规初级保健实践中的诊室血压和日间血压按年龄进行差异研究。为了评估年龄、心血管变量和诊室血压对诊室-日间血压差异的影响，我们建立了平均血压差异、白大衣高血压（诊室血压高而日间血压正常）和隐匿性高血压（诊室血压正常而日间血压高）的多变量回归模型。在大多数患者中，各年龄段的平均诊室血压值均高于日间血压。约36.7%的患者患有白大衣高血压（诊室收缩压为140-159 mmHg时占50%），3.9%的患者患有隐匿性高血压（诊室收缩压为130-139 mmHg时占18%）。年龄解释了定量或分类血压差异方差的0.1%至1.7%（P<0.001）。心血管变量额外解释了1.6%至3.4%的方差（P<0.001）。最后，诊室血压通常解释的方差多≥20%（P<0.01）。在这项常规临床实践的大型研究中，诊室血压将超过40%的患者高血压状态误诊。这种误诊受年龄影响不大，但在临界/1级高血压患者中更为明显。这些发现强化了动态血压监测在常规临床实践中定义血压状态的重要性。
