Department of Geriatric/Internal Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands.
Department of Vascular/Internal Medicine, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands.
Age Ageing. 2021 Jun 28;50(4):1229-1235. doi: 10.1093/ageing/afaa287.
assess how many patients with low ambulatory diastolic blood pressure (DBP) are not identified when relying on office DBP alone, and thus have 'masked diastolic hypotension'.
cross-sectional, retrospective cohort study.
academic hospital.
848 patients treated for hypertension who received ambulatory blood pressure monitoring (ABPM).
cut-off value between on- and off-target systolic blood pressure (SBP): 140 mmHg. Cut-off for low office and/or ambulatory DBP: DBP ≤ 70 mmHg. 'Masked diastolic hypotension' was defined as office DBP > 70 mmHg and mean ambulatory DBP ≤ 70 mmHg.
mean age of the sample was 60 ± 13 years, 50% was female, 37% had diabetes, 42% preexisting cardiovascular disease (CVD), mean office blood pressure (BP) was 134/79 mmHg. In all patients (n = 848), low office DBP was present in n = 84(10%), while n = 183(22%) had low ambulatory DBP. In all patients with normal-to-high office DBP (n = 764), n = 122(16%) had 'masked diastolic hypotension'. In this group, ambulatory DBP was 14-19 mmHg lower than office DBP. Patients with low ambulatory DBP were older, had more (cardiovascular) comorbidities, and used more (antihypertensive) drugs. Antihypertensive drugs were lowered or discontinued in 30% of all patients with 'masked diastolic hypotension' due to side effects.
'masked diastolic hypotension' is common among patients treated for hypertension, particularly in older patients with CVD (e.g. coronary artery disease, diabetes), patient groups in which the European Society of Cardiology/Hypertension guideline advises to prevent low DBP. Although it remains to be examined at which BP levels the harms of low DBP outweigh the benefits of lowering SBP, our observations are aimed to increase awareness among physicians.
评估仅依赖诊室舒张压（DBP）时，有多少舒张压较低的患者未被识别，从而存在“隐性舒张性低血压”。
横断面、回顾性队列研究。
学术医院。
接受动态血压监测（ABPM）治疗高血压的 848 例患者。
收缩压目标值与非目标值的截断值：140mmHg。诊室和/或动态 DBP 低值的截断值：DBP≤70mmHg。“隐性舒张性低血压”定义为诊室 DBP＞70mmHg 且平均动态 DBP≤70mmHg。
样本的平均年龄为 60±13 岁，50%为女性，37%患有糖尿病，42%患有心血管疾病（CVD），诊室血压（BP）平均为 134/79mmHg。在所有患者（n=848）中，n=84（10%）存在诊室 DBP 降低，n=183（22%）存在动态 DBP 降低。在所有诊室 DBP 正常至升高的患者（n=764）中，n=122（16%）存在“隐性舒张性低血压”。在这组患者中，动态 DBP 比诊室 DBP 低 14-19mmHg。与动态 DBP 降低相关的患者年龄更大，合并症更多（心血管疾病），且使用更多（降压）药物。由于副作用，30%的“隐性舒张性低血压”患者降低或停用了降压药物。
“隐性舒张性低血压”在高血压治疗患者中较为常见，特别是在患有 CVD（如冠状动脉疾病、糖尿病）的老年患者中，欧洲心脏病学会/高血压指南建议预防此类患者的 DBP 降低。虽然降低 SBP 的益处是否超过 DBP 降低的危害尚待研究，但我们的观察结果旨在提高医生的认识。
