Kollias A, Papadatos S S, Dominiczak A F, Parati G, Stergiou G S
Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece.
Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK.
Hellenic J Cardiol. 2020 May-Jun;61(3):174-177. doi: 10.1016/j.hjc.2019.01.005. Epub 2019 Jan 9.
This study assessed the diagnostic reliability of automated office blood pressure (OBP) measurements in treated hypertensive patients in primary care by evaluating the prevalence of white coat hypertension (WCH) and masked uncontrolled hypertension (MUCH) phenomena.
Primary care physicians, nationwide in Greece, assessed consecutive hypertensive patients on stable treatment using OBP (1 visit, triplicate measurements) and home blood pressure (HBP) measurements (7 days, duplicate morning and evening measurements). All measurements were performed using validated automated devices with bluetooth capacity (Omron M7 Intelli-IT). Uncontrolled OBP was defined as ≥140/90 mmHg, and uncontrolled HBP was defined as ≥135/85 mmHg.
A total of 790 patients recruited by 135 doctors were analyzed (age: 64.5 ± 14.4 years, diabetics: 21.4%, smokers: 20.6%, and average number of antihypertensive drugs: 1.6 ± 0.8). OBP (137.5 ± 9.4/84.3 ± 7.7 mmHg, systolic/diastolic) was higher than HBP (130.6 ± 11.2/79.9 ± 8 mmHg; difference 6.9 ± 11.6/4.4 ± 7.6 mmHg, p < 0.001). WCH phenomenon (high OBP with low HBP) was observed in 22.7% of the patients, MUCH (low OBP with high HBP) in 15.8%, uncontrolled hypertension (high OBP with high HBP) in 29.9%, and controlled hypertension (low OBP with low HBP) in 31.6%. In multivariate logistic regression analysis, WCH was determined by stage-1 systolic hypertension (odds ratio [OR] 8.6, 95% confidence intervals [CI] 5.7, 13.1) and female gender (OR 1.6, 95% CI 1.1, 2.4), whereas MUCH was determined by high-normal systolic OBP (OR 6.2, 95% CI 3.8, 10.1) and male gender (OR 2.0, 95% CI 1.2, 3.1).
In primary care, automated OBP measurements are misleading in approximately 40% of treated hypertensive patients. HBP monitoring is mandatory to avoid overtreatment of subjects with WCH phenomenon and prevent undertreatment and subsequent excess cardiovascular disease in MUCH.
本研究通过评估白大衣高血压（WCH）和隐匿性未控制高血压（MUCH）现象的患病率，来评估初级保健中接受治疗的高血压患者自动诊室血压（OBP）测量的诊断可靠性。
希腊全国的初级保健医生使用OBP（1次就诊，重复测量3次）和家庭血压（HBP）测量（7天，早晚重复测量）对连续接受稳定治疗的高血压患者进行评估。所有测量均使用具有蓝牙功能的经过验证的自动设备（欧姆龙M7 Intelli-IT）。未控制的OBP定义为≥140/90 mmHg，未控制的HBP定义为≥135/85 mmHg。
共分析了由135名医生招募的790例患者（年龄：64.5±14.4岁，糖尿病患者：21.4%，吸烟者：20.6%，平均抗高血压药物数量：1.6±0.8）。OBP（收缩压/舒张压为137.5±9.4/84.3±7.7 mmHg）高于HBP（130.6±11.2/79.9±8 mmHg；差值为6.9±11.6/4.4±7.6 mmHg，p<0.001）。22.7%的患者观察到WCH现象（OBP高而HBP低），15.8%的患者观察到MUCH（OBP低而HBP高），29.9%的患者观察到未控制高血压（OBP高且HBP高），31.6%的患者观察到控制良好的高血压（OBP低且HBP低）。在多因素逻辑回归分析中，WCH由1期收缩期高血压（比值比[OR]8.6，95%置信区间[CI]5.7，13.1）和女性性别（OR 1.6，95%CI 1.1，2.4）决定，而MUCH由收缩压OBP处于正常高值（OR 6.2，95%CI 3.8，10.1）和男性性别（OR 2.0，95%CI 1.2，3.1）决定。
在初级保健中，自动OBP测量在约40%接受治疗的高血压患者中具有误导性。必须进行HBP监测，以避免对有WCH现象的患者进行过度治疗，并防止MUCH患者治疗不足及随后出现过多的心血管疾病。
