Department of General Medicine, Eastern Health, Melbourne, Vic, Australia.
Eastern Health Clinical School, Department of Medicine, Monash University, Melbourne, Vic, Australia.
Heart Lung Circ. 2020 Jan;29(1):102-111. doi: 10.1016/j.hlc.2019.08.006. Epub 2019 Aug 16.
Masked phenomenon, Masked Hypertension (MHT) and Masked Uncontrolled Hypertension (MUCH) is a well-defined clinical entity. However, many aspects of MHT/MUCH remain unclear.
We systematically reviewed the published literature on MHT/MUCH from 1 January 2000 to 31 June 2018 with a particular focus on epidemiology, clinical significance, evaluation and management. Meta-analyses were performed with respect to prevalence, clinical significance and diagnostic agreement between home blood pressure (HBP) and ambulatory BP (ABP) measurements.
The overall weighted-mean prevalence of masked phenomenon was 11% [9,14]; MHT 10% [9,11]; and MUCH 13% [8,17]. The weighted-mean prevalence when expressed as a proportion of patients with normal office BP was 32% [25,40]; MHT 28% [15,41]; and MUCH 43% [29,57]. The prevalence of masked phenomenon determined by ABP (11% [8,14]) and HBP (13% [9,16]), was similar. However, ABP appeared to have a greater sensitivity, i.e. proportion of patients diagnosed as having MHT/MUCH was greater with ABP than with HBP (22% v 16%, p<0.05), when both methodologies were applied to the same cohort of patients. The prevalence of MHT was influenced by ethnicities and comorbidities, and in case of MUCH by anti-hypertensive treatment. MHT/MUCH was associated with increased risk of fatal and non-fatal cardiac/cerebrovascular events (relative risk [RR] 2.09 [1.80, 2.44]), and the risk was comparable to sustained hypertension (SHT) (RR 2.26 [1.84, 2.78]). The increased risk occurred regardless of the method of out of office BP assessment; the relative risks for ABP and HBP were 2.38 [1.90, 2.98] and 1.90 [1.57, 2.29] respectively. The diagnostic agreement between ABP and HBP was only modest, kappa = 0.46 [0.40, 0.52], even though the percentage agreement was 83%. The evidence for the management of MHT was scant.
MHT/MUCH is a common BP phenotype with a risk profile similar to that of SHT. Therefore, high risk patients should undergo out of office BP assessment, probably both by HBP and ABP, to confirm diagnosis and be considered for treatment.
掩蔽现象、掩蔽性高血压（MHT）和掩蔽性未控制高血压（MUCH）是一种明确的临床实体。然而，MHT/MUCH 的许多方面仍不清楚。
我们系统地回顾了 2000 年 1 月 1 日至 2018 年 6 月 31 日期间发表的关于 MHT/MUCH 的文献，特别关注流行病学、临床意义、评估和管理。对于家庭血压（HBP）和动态血压（ABP）测量之间的患病率、临床意义和诊断一致性，我们进行了荟萃分析。
总体加权平均掩蔽现象患病率为 11%[9,14]；MHT 为 10%[9,11]； MUCH 为 13%[8,17]。当以正常诊室血压患者的比例表示时，加权平均患病率为 32%[25,40]；MHT 为 28%[15,41]； MUCH 为 43%[29,57]。ABP（11%[8,14]）和 HBP（13%[9,16]）确定的掩蔽现象患病率相似。然而，ABP 似乎具有更高的敏感性，即通过 ABP 诊断为 MHT/MUCH 的患者比例大于 HBP（22%比 16%，p<0.05），当两种方法应用于同一患者队列时。MHT 的患病率受种族和合并症的影响，而 MUCH 则受抗高血压治疗的影响。MHT/MUCH 与致命和非致命性心脏/脑血管事件的风险增加相关（相对风险[RR]2.09[1.80，2.44]），其风险与持续性高血压（SHT）相当（RR 2.26[1.84，2.78]）。无论诊室外血压评估方法如何，风险均增加；ABP 和 HBP 的相对风险分别为 2.38[1.90，2.98]和 1.90[1.57，2.29]。ABP 和 HBP 之间的诊断一致性仅为中等，kappa=0.46[0.40，0.52]，尽管百分比一致率为 83%。MHT 管理的证据很少。
MHT/MUCH 是一种常见的血压表型，其风险特征与 SHT 相似。因此，高危患者应进行诊室外血压评估，可能同时进行 HBP 和 ABP 评估，以确认诊断并考虑治疗。
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