隐匿性和白大衣未控制高血压与心房颤动风险。

Risk of Atrial Fibrillation in Masked and White Coat Uncontrolled Hypertension.

机构信息

Department of Medical, Oral and Biotechnological Sciences, University "Gabriele d'Annunzio", Chieti-Pescara, Chieti, Italy.

Department of Medicine and Aging Sciences, University "Gabriele d'Annunzio", Chieti-Pescara, Chieti, Italy.

出版信息

Am J Hypertens. 2021 May 22;34(5):504-510. doi: 10.1093/ajh/hpaa185.

DOI:10.1093/ajh/hpaa185

PMID:33186441

Abstract

BACKGROUND

Risk of atrial fibrillation (AF) in masked and white coat uncontrolled hypertension (MUCH and WUCH, respectively) has not yet been investigated. We assessed the risk of new-onset AF in MUCH and WUCH detected by ambulatory blood pressure (BP) monitoring.

METHODS

The occurrence of AF was evaluated in 2,135 treated hypertensive patients aged >40 years, with baseline sinus rhythm, by electrocardiogram. Controlled hypertension (CH) was defined as clinic BP <140/90 mm Hg and daytime BP, regardless of nighttime BP, <135/85 mm Hg, MUCH as clinic BP <140/90 mm Hg and daytime BP ≥135 and/or ≥85 mm Hg, WUCH as clinic BP ≥140 and/or ≥90 mm Hg and daytime BP <135/85 mm Hg, and sustained uncontrolled hypertension (SUCH) as clinic BP ≥140 and/or ≥90 mm Hg and daytime BP ≥135 and/or ≥85 mm Hg.

RESULTS

MUCH was identified in 203 patients (9.5% of all the population, 29% of those with normal clinic BP) and WUCH in 503 patients (23.5% of all the population, 35% of those with high clinic BP). During the follow-up (mean 9.7 years), 116 cases of AF occurred. After adjustment for covariates, patients with MUCH (hazard ratio 2.02, 95% confidence interval, 1.06-3.85) and SUCH (hazard ratio 1.83, 95% confidence interval, 1.04-3.21) had higher risk of new-onset AF than those with CH, whereas those with WUCH (hazard ratio 1.12, 95% confidence interval, 0.59-2.13) did not.

CONCLUSIONS

When compared with patients with CH, those with MUCH and SUCH are at higher risk (approximately doubled) of new-onset AF, whereas those with WUCH are not.

摘要

背景

尚未研究通过动态血压监测（ABPM）检测到的隐匿性和白大衣未控制高血压（MUCH 和 WUCH）中的心房颤动（AF）风险。我们评估了通过 ABPM 检测到的 MUCH 和 WUCH 中新发 AF 的风险。

方法

通过心电图评估了 2135 名年龄大于 40 岁的接受治疗的高血压患者的 AF 发生情况，这些患者的基线心律为窦性。控制高血压（CH）定义为诊室血压<140/90mmHg，且无论夜间血压如何，日间血压<135/85mmHg，MUCH 定义为诊室血压<140/90mmHg，且日间血压≥135mmHg 和/或≥85mmHg，WUCH 定义为诊室血压≥140mmHg 和/或≥90mmHg，且日间血压<135/85mmHg，持续性未控制高血压（SUCH）定义为诊室血压≥140mmHg 和/或≥90mmHg，且日间血压≥135mmHg 和/或≥85mmHg。

结果

在所有人群中，203 名患者（9.5%）和 503 名患者（23.5%）存在 MUCH（所有正常诊室血压患者的 29%，所有高诊室血压患者的 35%）和 WUCH。在随访期间（平均 9.7 年），发生了 116 例 AF。在校正了混杂因素后，与 CH 患者相比，MUCH（风险比 2.02，95%置信区间，1.06-3.85）和 SUCH（风险比 1.83，95%置信区间，1.04-3.21）患者新发 AF 的风险更高，而 WUCH 患者（风险比 1.12，95%置信区间，0.59-2.13）则不然。