Department of Medicine and Surgery, University of Milano-Bicocca.
Clinical Research Unit, Istituto Auxologico Italiano IRCCS.
J Hypertens. 2018 Sep;36(9):1833-1839. doi: 10.1097/HJH.0000000000001767.
In the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study, clinical and metabolic variables as well as office, home and ambulatory blood pressure (BP) values were simultaneously measured at baseline and after a 10-year follow-up. The study design allowed us to assess the value of selective and combined elevation of different BP phenotypes in predicting new-onset metabolic syndrome (MetS).
The present analysis included 1182 participants without MetS at baseline, as defined by the APT III criteria. On the basis of office, 24-h ambulatory BP and home values, participants were divided into four groups: normal, white-coat hypertension (WCH), masked hypertension and sustained hypertension.
Compared with participants with in-office and out-of-office normal BP, a greater incidence of new-onset age-adjusted and sex-adjusted MetS was observed in WCH (OR = 1.75, CI 1.01-3.04, P = 0.0046), masked hypertension (OR = 2.58, CI 1.26-5.30; P = 0.009) and sustained hypertension (OR = 2.14, CI 1.20-3.79, P = 0.009)) when out-of-office BP was defined by ambulatory criteria. This was not the case when out-of-office BP was defined by home criteria, as only the WCH group showed a greater risk (OR 2.16, CI 1.28-3.63, P = 0.003). Similar findings were obtained for single components of the MetS such as abdominal obesity and hyperglycemia.
Our study provides evidence that either isolated or combined BP elevations identified by office/ambulatory measurements, carry an increased risk of new-onset MetS, whereas, only WCH is associated with a greater risk of incident MetS whenever BP phenotypes are identified by office/home measurements. In a clinical perspective, a comprehensive evaluation of BP status based on office/ambulatory measurements may improve diagnosis of new-onset MetS and activate measures for its prevention.
在 Pressioni Arteriose Monitorate e Loro Associazioni（PAMELA）研究中，临床和代谢变量以及诊室、家庭和动态血压（BP）值在基线和 10 年随访时同时测量。该研究设计使我们能够评估不同 BP 表型选择性和联合升高在预测新发生代谢综合征（MetS）中的价值。
本分析包括 1182 名基线时无 MetS 的参与者，根据 APT III 标准定义。基于诊室、24 小时动态 BP 和家庭值，参与者被分为四组：正常、白大衣高血压（WCH）、隐蔽性高血压和持续性高血压。
与诊室和诊室外正常 BP 的参与者相比，WCH（OR=1.75，CI 1.01-3.04，P=0.0046）、隐蔽性高血压（OR=2.58，CI 1.26-5.30；P=0.009）和持续性高血压（OR=2.14，CI 1.20-3.79，P=0.009）的新发生年龄调整和性别调整后的 MetS 发生率更高，当通过动态标准定义诊室外 BP 时。当通过家庭标准定义诊室外 BP 时并非如此，因为只有 WCH 组显示出更高的风险（OR 2.16，CI 1.28-3.63，P=0.003）。代谢综合征的单一成分，如腹型肥胖和高血糖，也有类似的发现。
我们的研究提供了证据，表明通过诊室/动态测量确定的孤立或联合 BP 升高，增加了新发生 MetS 的风险，而无论何时通过诊室/家庭测量确定 BP 表型，只有 WCH 与更大的 MetS 风险相关。从临床角度来看，基于诊室/动态测量的全面 BP 状态评估可能会改善新发生 MetS 的诊断，并采取措施预防其发生。
