From the INSERM, Centre d'Investigations Cliniques- Plurithématique 1418, Paris, France (I.H., H.P., M.A.).
ESH Hypertension excellence center, Hopital Saint André, University hospital of Bordeaux, France (P.G., A.C.).
Hypertension. 2019 Nov;74(5):1096-1103. doi: 10.1161/HYPERTENSIONAHA.119.13520. Epub 2019 Sep 23.
Clinic-ambulatory blood pressure (BP) difference is influenced by patients- and device-related factors and inadequate clinic-BP measurement. We investigated whether nonadherence to antihypertensive medications may also influence this difference in a post hoc analysis of the DENERHTN trial (Renal Denervation for Hypertension). We pooled the data of 77 out of 106 evaluable patients with apparent resistant hypertension who received a standardized antihypertensive treatment and had both ambulatory BP and drug-screening results available at baseline after 1 month of standardized triple therapy and at 6 months on a median of 5 antihypertensive drugs. After drug assay samplings on study visits, patients took their antihypertensive treatment under supervision immediately after the start of the ambulatory BP recording, and supine clinic BP was measured 24 hours post-dosing; both allowed to calculate the clinic minus daytime ambulatory systolic BP (SBP) difference (clinic-SBP-day-SBP). A total of 29 (37.7%) were found nonadherent to medications at baseline and 38 (49.4%) at 6 months. At baseline, the mean clinic-SBP-day-SBP difference in the nonadherent group was 12.7 mm Hg (95% CI, 7.8-17.7 mm Hg, <0.001). In contrast, clinic SBP was almost identical to day-SBP in the adherent group (clinic-SBP-day-SBP difference, 0.1 mm Hg; 95% CI, -3.3 to 3.5 mm Hg; =0.947). Similar observations were made at 6 months. Using receiver operating characteristics curves, we found that a 6 mm Hg cutoff of clinic-SBP-day-SBP difference had 67% sensitivity and 69% specificity to predict nonadherence to the triple therapy at baseline. In conclusion, a large clinic-SBP-day-SBP difference may help discriminating between adherence and nonadherence to treatment in patients with resistant hypertension. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT01570777.
诊室-动态血压（BP）差值受患者和设备相关因素以及诊室 BP 测量不足的影响。我们在 DENERHTN 试验（高血压肾去神经术）的事后分析中研究了抗高血压药物治疗的不依从是否也会影响这种差值。我们汇集了 106 名可评估患者中 77 名的资料，这些患者患有明显的难治性高血压，在接受标准化抗高血压治疗后，在标准三联治疗 1 个月后和在中位数为 5 种降压药物的 6 个月时，都有动态 BP 和药物筛查结果。在研究就诊时进行药物检测采样后，患者在开始动态 BP 记录后立即服用降压治疗药物，并且在 24 小时后测量卧位诊室 BP；两者都用于计算诊室收缩压（SBP）-白天动态 SBP 差值（诊室-SBP-白天-SBP）。基线时有 29 名（37.7%）患者被发现不依从药物治疗，6 个月时有 38 名（49.4%）。在基线时，不依从组的平均诊室-SBP-白天-SBP 差值为 12.7mmHg（95%CI，7.8-17.7mmHg，<0.001）。相比之下，在依从组中，诊室 SBP 几乎与白天-SBP 相同（诊室-SBP-白天-SBP 差值为 0.1mmHg；95%CI，-3.3 至 3.5mmHg；=0.947）。在 6 个月时也观察到了类似的结果。使用接收器工作特征曲线，我们发现，以 6mmHg 为截断值，诊室-SBP-白天-SBP 差值可在基线时预测对三联治疗的不依从，其灵敏度为 67%，特异性为 69%。总之，在难治性高血压患者中，较大的诊室-SBP-白天-SBP 差值可能有助于区分治疗的依从性和不依从性。临床试验注册- URL：https://www.clinicaltrials.gov。独特标识符：NCT01570777。
