Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Health Promotion, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
J Clin Hypertens (Greenwich). 2021 Mar;23(3):595-605. doi: 10.1111/jch.14113. Epub 2020 Dec 5.
The objective of this study was to compare the diagnostic accuracy of office blood pressure (BP) threshold of 140/90 and 130/80 mmHg for correctly identifying uncontrolled out-of-office BP in apparent treatment-resistant hypertension (aTRH). We analyzed 468 subjects from a prospectively enrolled cohort of patients with resistant hypertension in South Korea (clinicaltrials.gov: NCT03540992). Resistant hypertension was defined as office BP ≥ 130/80 mmHg with three different classes of antihypertensive medications including thiazide-type/like diuretics, or treated hypertension with four or more different classes of antihypertensive medications. We conducted different types of BP measurements including office BP, automated office BP (AOBP), home BP, and ambulatory BP. We defined uncontrolled out-of-office BP as daytime BP ≥ 135/85 mmHg and/or home BP ≥ 135/85 mmHg. Among subjects with office BP < 140/90 mmHg and subjects with office BP < 130/80 mmHg, 66% and 55% had uncontrolled out-of-office BP, respectively. The prevalence of controlled and masked uncontrolled hypertension was lower, and the prevalence of white-coat and sustained uncontrolled hypertension was higher, with a threshold of 130/80 mmHg than of 140/90 mmHg, for both office BP and AOBP. The office BP threshold of 130/80 mmHg was better able to diagnose uncontrolled out-of-office BP than 140/90 mmHg, and the net reclassification improvement (NRI) was 0.255. The AOBP threshold of 130/80 mmHg also revealed better diagnostic accuracy than 140/90 mmHg, with NRI of 0.543. The office BP threshold of 130/80 mmHg showed better than 140/90 mmHg in terms of the correspondence to out-of-office BP in subjects with aTRH.
本研究旨在比较诊室血压（BP）阈值 140/90mmHg 和 130/80mmHg 在识别明显治疗抵抗性高血压（aTRH）中诊室外 BP 控制不佳的诊断准确性。我们分析了来自韩国一项前瞻性纳入的难治性高血压患者队列研究中的 468 例患者（clinicaltrials.gov：NCT03540992）。难治性高血压定义为诊室 BP≥130/80mmHg，使用三种不同类别的降压药物，包括噻嗪类/类似利尿剂，或使用四种或更多种不同类别的降压药物治疗的高血压。我们进行了不同类型的 BP 测量，包括诊室 BP、自动诊室 BP（AOBP）、家庭 BP 和动态 BP。我们将诊室外 BP 控制不佳定义为日间 BP≥135/85mmHg 和/或家庭 BP≥135/85mmHg。在诊室 BP<140/90mmHg 和诊室 BP<130/80mmHg 的患者中，分别有 66%和 55%的患者存在诊室外 BP 控制不佳。与诊室 BP 阈值 140/90mmHg 相比，阈值 130/80mmHg 时诊室 BP 和 AOBP 下的控制和隐匿性未控制高血压的发生率较低，白大衣和持续性未控制高血压的发生率较高，差异有统计学意义（均 P<0.001）。诊室 BP 阈值 130/80mmHg 较 140/90mmHg 能更好地诊断诊室外 BP 控制不佳，净重新分类改善（NRI）为 0.255。AOBP 阈值 130/80mmHg 也显示出比 140/90mmHg 更好的诊断准确性，NRI 为 0.543。在 aTRH 患者中，与诊室 BP 阈值 140/90mmHg 相比，诊室 BP 阈值 130/80mmHg 与诊室外 BP 更相符。
