Cesario Vincenzo, Presta Vivianne, Figliuzzi Ilaria, Citoni Barbara, Battistoni Allegra, Miceli Francesca, Volpe Massimo, Tocci Giuliano
Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Hypertension Unit, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy.
IRCCS Neuromed, Pozzilli, Italy.
High Blood Press Cardiovasc Prev. 2020 Jun;27(3):195-201. doi: 10.1007/s40292-020-00382-1. Epub 2020 May 2.
Masked hypertension (MHT) is a clinical condition characterized by normal blood pressure (BP) levels during clinical consultation and above normal out-of-office BP values. MHT is associated to an increased risk of developing hypertension-mediated organ damage (HMOD) and major cardiovascular (CV) outcomes, such as myocardial infarction, stroke, and hospitalizations due to CV causes, as well as to metabolic abnormalities and diabetes, thus further promoting the development and progression of atherosclerotic disease. Previous studies showed contrasting data on prevalence and clinical impact of MHT, due to not uniform diagnostic criteria (including either home or 24-h ambulatory BP measurements, or both) and background antihypertensive treatment. Whatever the case, over the last few years the widespread diffusion of validated devices for home BP monitoring has promoted a better diagnostic assessment and proper identification of individuals with MHT in a setting of clinical practice, thus resulting in increased prevalence of this clinical condition with potential clinical and socio-economic consequences. Several other items, in fact, remain unclear and debated, particularly regarding the therapeutic approach to MHT. The aim of this narrative review is to illustrate the clinical definition of MHT, to analyze the diagnostic algorithm, and to discuss the potential pharmacological approaches to be adopted in this clinical condition, in the light of the recommendations of the recent European hypertension guidelines.
隐匿性高血压（MHT）是一种临床状况，其特征为临床会诊期间血压（BP）水平正常，而诊室外血压值高于正常水平。MHT与高血压介导的器官损害（HMOD）风险增加以及主要心血管（CV）结局相关，如心肌梗死、中风以及因心血管原因住院，还与代谢异常和糖尿病相关，从而进一步促进动脉粥样硬化疾病的发展和进展。先前的研究显示，由于诊断标准不统一（包括家庭血压测量或24小时动态血压测量，或两者皆有）以及背景抗高血压治疗，关于MHT的患病率和临床影响的数据存在差异。无论如何，在过去几年中，经过验证的家庭血压监测设备的广泛普及促进了在临床实践中对MHT患者进行更好的诊断评估和准确识别，从而导致这种临床状况的患病率增加，并带来潜在的临床和社会经济后果。事实上，还有其他几个问题仍不明确且存在争议，特别是关于MHT的治疗方法。本叙述性综述的目的是根据近期欧洲高血压指南的建议，阐述MHT的临床定义，分析诊断算法，并讨论在这种临床状况下可能采用的药物治疗方法。
