动态血压和家庭血压定义的掩蔽性高血压和掩蔽性未控制高血压的前瞻性观察性研究的荟萃分析比较

A comparative meta-analysis of prospective observational studies on masked hypertension and masked uncontrolled hypertension defined by ambulatory and home blood pressure.

机构信息

Centre for Epidemiological Studies and Clinical Trials and Centre for Vascular Evaluations, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

出版信息

J Hypertens. 2019 Sep;37(9):1775-1785. doi: 10.1097/HJH.0000000000002109.

DOI:10.1097/HJH.0000000000002109

PMID:31219948

Abstract

BACKGROUND

In a comparative meta-analysis, we investigated the prognostic value of masked hypertension and masked uncontrolled hypertension defined by ambulatory or home blood pressure (BP) monitoring.

METHODS

We searched English literature published till 2 September 2018 to identify prospective observational studies. Masked hypertension was defined as a normal clinic BP (<140/90 mmHg) in the presence of an elevated 24 h, daytime or night-time ambulatory or home BP. Clinical outcomes included all-cause and cardiovascular mortality, and fatal and nonfatal cardiovascular, stroke, cardiac, coronary and renal disease events.

RESULTS

In total, 21 studies (n = 130 318) were included. Overall, compared with normotensive participants, masked hypertensive patients had a 5.7/2.9 mmHg higher clinic BP and 18.7/9.8 mmHg higher out-of-office BP. The pooled risk ratio for masked hypertension versus normotension was 1.67 (95% confidence interval, 1.32-2.13) and 2.19 (1.72-2.78) for all-cause (eight studies) and cardiovascular mortality (three studies), respectively, and 1.71 (1.53-1.91), 1.95 (1.36-2.80), 1.76 (1.33-2.33), 1.62 (0.27-9.60), 3.85 (2.03-7.31) for fatal and nonfatal cardiovascular (15 studies), stroke (two studies), cardiac (two studies), coronary (two studies) and renal disease events (two studies), respectively. Risk ratios for all-cause mortality (1.78 versus 1.40, P = 0.16) and fatal and nonfatal cardiovascular events (1.81 versus 1.61, P = 0.29) were similar between studies on ambulatory and home BP monitoring in the overall analyses. The analyses in subgroups according to treatment status (untreated, treated or mixed) and sampling approach (population or referred patients) were confirmatory.

CONCLUSION

Masked hypertension and masked uncontrolled hypertension were associated with unfavorable clinical outcomes, regardless of the out-of-office BP monitoring techniques.

摘要

背景

在一项比较性的荟萃分析中，我们研究了通过动态血压或家庭血压监测定义的隐匿性高血压和隐匿性未控制高血压的预后价值。

方法

我们检索了截至 2018 年 9 月 2 日发表的英文文献，以确定前瞻性观察性研究。隐匿性高血压定义为动态血压或家庭血压监测时存在 24 小时、白天或夜间的升高，但诊室血压正常(<140/90mmHg)。临床结局包括全因和心血管死亡率以及致命和非致命心血管、卒中和心脏、冠状动脉和肾脏疾病事件。

结果

共纳入 21 项研究（n=130318 人）。总体而言，与血压正常的参与者相比，隐匿性高血压患者的诊室血压高 5.7/2.9mmHg，诊室外血压高 18.7/9.8mmHg。隐匿性高血压与正常血压相比的汇总风险比分别为 1.67（95%置信区间，1.32-2.13）和 2.19（1.72-2.78），用于全因（8 项研究）和心血管死亡率（3 项研究），对于致命和非致命心血管（15 项研究）、卒中和心脏（2 项研究）、冠状动脉（2 项研究）和肾脏疾病事件（2 项研究），分别为 1.71（1.53-1.91）、1.95（1.36-2.80）、1.76（1.33-2.33）、1.62（0.27-9.60）和 3.85（2.03-7.31）。全因死亡率（1.78 与 1.40，P=0.16）和致命和非致命心血管事件（1.81 与 1.61，P=0.29）的风险比在总体分析中，动态血压和家庭血压监测的研究之间相似。根据治疗状态（未治疗、治疗或混合）和抽样方法（人群或转诊患者）进行的亚组分析结果是确认性的。