Kim Byong-Kyu, Rhee Moo-Yong
Division of Cardiology, Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju Hospital, Gyeongju 38067, Korea.
Cardiovascular Center, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi 10326, Korea.
Healthcare (Basel). 2020 May 3;8(2):122. doi: 10.3390/healthcare8020122.
Our study evaluated whether there were differences in the prevalence of white-coat hypertension (WH) and masked hypertension (MH) based on the 2018 ESC/ESH and 2017 ACC/AHA hypertension guidelines in Korea. The motivation was the lowering of the diagnostic threshold for hypertension in the 2017 ACC/AHA guidelines. Of 319 participants without antihypertensive drug history and with suspected hypertension based on outpatient clinic blood pressure (BP) measured by physicians, 263 participants (51.6 ± 9.6 years; 125 men) who had valid research-grade office BP and 24-h ambulatory BP measurements were enrolled. WH prevalence based on daytime ambulatory BP among normotensive individuals was lower with the ESC/ESH guidelines than the ACC/AHA guidelines (29.0% vs. 71.4%, < 0.001). However, MH prevalence based on daytime ambulatory BP among hypertensive individuals was higher based on the ESC/ESH guidelines (21.6% vs. 1.8%, < 0.001). Seventy percent of WH cases (2017 ACC/AHA guidelines) and 95.2% of MH cases (2018 ESC/ESH guidelines) occurred in individuals with systolic BP of 130-139 mmHg and/or diastolic BP of 80-89 mmHg. The diagnostic threshold of the 2017 ACC/AHA guidelines yielded a higher prevalence of WH compared to that of the 2018 ESC/ESH guidelines. However, the prevalence of MH was higher with the 2018 ESC/ESH guidelines than with the 2017 ACC/AHA guidelines. The high prevalence of WH and MH in people with a systolic BP of 130-139 mmHg or diastolic BP of 80-89 mmHg suggests the need for a more active out-of-office BP measurement in this patient group.
我们的研究评估了根据2018年欧洲心脏病学会/欧洲高血压学会（ESC/ESH）和2017年美国心脏病学会/美国心脏协会（ACC/AHA）高血压指南，韩国白大衣高血压（WH）和隐匿性高血压（MH）的患病率是否存在差异。动机是2017年ACC/AHA指南中高血压诊断阈值的降低。在319名无抗高血压药物治疗史且根据医生在门诊测量的血压（BP）怀疑患有高血压的参与者中，纳入了263名（51.6±9.6岁；125名男性）有有效研究级诊室血压和24小时动态血压测量值的参与者。根据ESC/ESH指南，正常血压个体中基于日间动态血压的WH患病率低于ACC/AHA指南（29.0%对71.4%，<0.001）。然而，根据ESC/ESH指南，高血压个体中基于日间动态血压的MH患病率更高（21.6%对1.8%，<0.001）。70%的WH病例（2017年ACC/AHA指南）和95.2%的MH病例（2018年ESC/ESH指南）发生在收缩压为130 - 139 mmHg和/或舒张压为80 - 89 mmHg的个体中。与2018年ESC/ESH指南相比，2017年ACC/AHA指南的诊断阈值导致WH患病率更高。然而，2018年ESC/ESH指南的MH患病率高于2017年ACC/AHA指南。收缩压为130 - 139 mmHg或舒张压为80 - 89 mmHg的人群中WH和MH的高患病率表明，该患者群体需要更积极地进行诊室外血压测量。
