Palla Mohan, Saber Hamidreza, Konda Sanjana, Briasoulis Alexandros
Division of Cardiology, Wayne State University, Detroit, MI.
Section of Heart Failure and Transplant, Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Integr Blood Press Control. 2018 Jan 5;11:11-24. doi: 10.2147/IBPC.S128947. eCollection 2018.
As many as one-third of individuals with normal office blood pressure (BP) are diagnosed with masked hypertension (HTN) based on ambulatory BP measurements (ABPM). Masked HTN is associated with higher risk of sustained HTN (SH) and increased cardiovascular morbidity.
The present study was designed to systematically review cohort studies and assess the effects of masked HTN compared to normotension and SH on cardiovascular events and all-cause mortality. We systematically searched the electronic databases, such as MEDLINE, PubMed, Embase, and Cochrane for prospective cohort studies, which evaluated participants with office and ambulatory and/or home BP.
We included nine studies with a total number of 14729 participants (11245 normotensives, 3484 participants with masked HTN, 1984 participants with white-coat HTN, and 5143 participants with SH) with a mean age of 58 years and follow-up of 9.5 years. Individuals with masked HTN had significantly increased rates of cardiovascular events and all-cause mortality than normotensives and white-coat HTN and had lower rates of cardiovascular events than those with SH (odds ratio 0.61, 95% confidence interval 0.42-0.89; =0.010; =84%). Among patients on antihypertensive treatment, masked HTN was associated with higher rates of cardiovascular events than in those with normotension and white-coat HTN and similar rates of cardiovascular events in those with treated SH.
Prompt screening of high-risk individuals with home BP measurements and ABPM, the diagnosis of masked HTN, and the initiation of treatment, may mitigate the adverse cardiovascular effects of masked HTN.
多达三分之一的办公室血压（BP）正常的个体基于动态血压测量（ABPM）被诊断为隐匿性高血压（HTN）。隐匿性HTN与持续性HTN（SH）风险增加及心血管发病率升高相关。
本研究旨在系统评价队列研究，并评估隐匿性HTN与正常血压及SH相比对心血管事件和全因死亡率的影响。我们系统检索了电子数据库，如MEDLINE、PubMed、Embase和Cochrane，以查找前瞻性队列研究，这些研究评估了办公室、动态和/或家庭血压的参与者。
我们纳入了9项研究，共有14729名参与者（11245名血压正常者、3484名隐匿性HTN参与者、1984名白大衣HTN参与者和5143名SH参与者），平均年龄58岁，随访9.5年。隐匿性HTN个体的心血管事件和全因死亡率显著高于血压正常者和白大衣HTN个体，且心血管事件发生率低于SH个体（优势比0.61，95%置信区间0.42 - 0.89；P = 0.010；I² = 84%）。在接受抗高血压治疗的患者中，隐匿性HTN与心血管事件发生率高于血压正常者和白大衣HTN个体相关，且与接受治疗的SH个体的心血管事件发生率相似。
通过家庭血压测量和ABPM对高危个体进行及时筛查、隐匿性HTN的诊断及治疗启动，可能减轻隐匿性HTN的不良心血管影响。
