Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Blood Press. 2020 Oct;29(5):299-307. doi: 10.1080/08037051.2020.1763159. Epub 2020 May 13.
Masked hypertension (MHT) is characterised as an office normotension in the presence of out-of-office hypertension, and can be further categorised as isolated daytime (dMHT), night-time (nMHT) or day-night MHT (dnMHT) according to the time when hypertension is present. MHT is associated with adverse cardiovascular outcome. However, no previous studies contrasted these MHT subtypes in their associations with target organ damage (TOD). Consecutive untreated patients referred for ambulatory blood pressure (BP) monitoring to our Hypertension Clinic were recruited. Office and ambulatory BPs were measured using the Omron 7051 and SpaceLabs 90217 monitors, respectively. The BP thresholds of daytime and night-time hypertension were of ≥135/85 mmHg and ≥120/70 mmHg, respectively. We performed various TOD measurements, including carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (cIMT), left ventricular mass index (LVMI) and E/E', estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR). The 1808 participants (mean age, 51 years; women, 52%) included 672 (37.2%) MHT subjects, among whom 123 (18.3%) had dMHT, 78 (11.6%) nMHT, and 471 (70.1%) dnMHT. In all participants as well as patients with office normotension ( = 1222), ambulatory daytime and night-time BPs were similarly associated with all TOD measurements ( ≥ 0.20) after multivariate adjustment. Compared to normotensive subjects ( < 0.05), patients with dMHT had faster cfPWV (7.81 vs. 7.58 m/s) and thicker cIMT (637.6 vs. 610.4 µm), patients with nMHT had thicker cIMT (641.8 vs. 610.4 µm) and increased UACR (0.79 vs. 0.59 mg/mmol), and patients with dnMHT had all worse TOD measures mentioned-above plus elevated eGFR (120.7 vs. 116.8 ml/min/1.73m). MHT was associated with TOD irrespective of subtype, although TOD varied slightly across these subtypes. The study highlights the importance of controlling both daytime and night-time BP in hypertensive patients.
隐匿性高血压（MHT）的特征是诊室血压正常但存在诊室外高血压，根据高血压发生的时间，可进一步分为孤立性日间（dMHT）、夜间（nMHT）或日间-夜间 MHT（dnMHT）。MHT 与不良心血管结局相关。然而，以前的研究并没有比较这些 MHT 亚型与靶器官损伤（TOD）之间的关联。我们招募了因诊室血压监测而被转诊到高血压诊所的连续未经治疗的患者。使用欧姆龙 7051 和 SpaceLabs 90217 监测仪分别测量诊室和动态血压。日间和夜间高血压的血压阈值分别为≥135/85mmHg 和≥120/70mmHg。我们进行了各种 TOD 测量，包括颈股脉搏波速度（cfPWV）、颈动脉内膜中层厚度（cIMT）、左心室质量指数（LVMI）和 E/E'、估算肾小球滤过率（eGFR）和尿白蛋白与肌酐比值（UACR）。1808 名参与者（平均年龄 51 岁，女性占 52%）包括 672 名（37.2%）MHT 患者，其中 123 名（18.3%）为 dMHT，78 名（11.6%）为 nMHT，471 名（70.1%）为 dnMHT。在所有参与者以及诊室血压正常的患者（ = 1222）中，经多变量调整后，日间和夜间动态血压与所有 TOD 测量值（ ≥ 0.20）均呈类似相关性。与血压正常的受试者相比（ < 0.05），dMHT 患者的 cfPWV 更快（7.81 比 7.58m/s），cIMT 更厚（637.6 比 610.4µm），nMHT 患者的 cIMT 更厚（641.8 比 610.4µm），UACR 更高（0.79 比 0.59mg/mmol），dnMHT 患者 TOD 上述所有指标均较差，并且 eGFR 升高（120.7 比 116.8ml/min/1.73m）。MHT 与 TOD 相关，无论亚型如何，尽管这些亚型之间 TOD 略有差异。该研究强调了控制高血压患者日间和夜间血压的重要性。
