From Department of Medicine, Columbia University Medical Center, New York, NY (D.E.A, N.A.B, D.N.P, I.M.K., J.E.S., D.S.).
Department of Epidemiology, University of Alabama at Birmingham (P.M.).
Hypertension. 2018 Nov;72(5):1200-1207. doi: 10.1161/HYPERTENSIONAHA.118.11319.
Guidelines recommend measuring out-of-clinic blood pressure (BP) to identify masked hypertension (MHT) defined by out-of-clinic BP in the hypertensive range among individuals with clinic-measured BP not in the hypertensive range. The aim of this study was to determine the overlap between ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) for the detection of MHT. We analyzed data from 333 community-dwelling adults not taking antihypertensive medication with clinic BP <140/90 mm Hg in the IDH study (Improving the Detection of Hypertension). Any MHT was defined by the presence of daytime MHT (mean daytime BP ≥135/85 mm Hg), 24-hour MHT (mean 24-hour BP ≥130/80 mm Hg), or nighttime MHT (mean nighttime BP ≥120/70 mm Hg). Home MHT was defined as mean BP ≥135/85 mm Hg on HBPM. The prevalence of MHT was 25.8% for any MHT and 11.1% for home MHT. Among participants with MHT on either ABPM or HBPM, 29.5% had MHT on both ABPM and HBPM; 61.1% had MHT only on ABPM; and 9.4% of participants had MHT only on HBPM. After multivariable adjustment and compared with participants without MHT on ABPM and HBPM, those with MHT on both ABPM and HBPM and only on ABPM had a higher left ventricular mass index (mean difference [SE], 12.7 [2.9] g/m, P<0.001; and 4.9 [2.1] g/m, P=0.022, respectively), whereas participants with MHT only on HBPM did not have an increased left ventricular mass index (mean difference [SE], -1.9 [4.8] g/m, P=0.693). These data suggest that conducting ABPM will detect many individuals with MHT who have an increased cardiovascular disease risk.
指南建议测量诊室外血压（BP）以识别隐匿性高血压（MHT），其定义为诊室血压未达到高血压范围，但诊室外血压处于高血压范围内的个体。本研究旨在确定动态血压监测（ABPM）和家庭血压监测（HBPM）在检测 MHT 中的重叠。我们分析了 IDH 研究（改善高血压检出率）中 333 名未服用降压药物的社区居住成年人的数据，这些成年人的诊室血压<140/90mmHg。任何 MHT 定义为日间 MHT（平均日间 BP≥135/85mmHg）、24 小时 MHT（平均 24 小时 BP≥130/80mmHg）或夜间 MHT（平均夜间 BP≥120/70mmHg）存在。家庭 MHT 定义为 HBPM 平均 BP≥135/85mmHg。任何 MHT 的患病率为 25.8%，家庭 MHT 的患病率为 11.1%。在 ABPM 或 HBPM 上存在 MHT 的参与者中，29.5%在 ABPM 和 HBPM 上均存在 MHT；61.1%仅在 ABPM 上存在 MHT；9.4%的参与者仅在 HBPM 上存在 MHT。经过多变量调整后，与 ABPM 和 HBPM 上均无 MHT 的参与者相比，ABPM 和 HBPM 上均存在 MHT 且仅在 ABPM 上存在 MHT 的参与者左心室质量指数更高（平均差异[SE]，12.7[2.9]g/m，P<0.001；和 4.9[2.1]g/m，P=0.022），而仅在 HBPM 上存在 MHT 的参与者的左心室质量指数没有增加（平均差异[SE]，-1.9[4.8]g/m，P=0.693）。这些数据表明，进行 ABPM 将检测到许多存在心血管疾病风险增加的 MHT 患者。
