Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
Department of Medicine and Surgery, University of Insubria and Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy.
Ann Med. 2021 Dec;53(1):2050-2059. doi: 10.1080/07853890.2021.1999493.
Hypertension is characterised by a high prevalence, low awareness and poor control among rheumatoid arthritis (RA) patients. Correct blood pressure (BP) measurement is highly important in these subjects. The "unattended" BP measurement aims to reduce the "white-coat effect," a phenomenon associated with cardiovascular risk. Data on "unattended" BP measurement in RA and its impact on hypertensive organ damage are very limited.
BP was measured in the same patient both traditionally ("attended" BP) and by the "unattended" protocol (3 automated office BP measurements, at 1-min intervals, after 5 min of rest, with patient left alone) by a randomised cross-over design. Patients underwent clinical examination, 12-lead electrocardiography and trans-thoracic echocardiography to evaluate cardiac damage.
Sixty-two RA patients (mean age 67 ± 9 years, 87% women) were enrolled. Hypertension was diagnosed in 79% and 66% of patients according to ACC/AHA and ESC/ESH criteria, respectively. Concordance correlation coefficients between the two techniques were 0.55 (95%, CI 0.38-0.68) for systolic BP and 0.73 (95%, CI 0.60-0.82) for diastolic BP. "Unattended" (121.7/68.6 mmHg) was lower than "attended" BP (130.5/72.8 mmHg) for systolic and diastolic BP (both < .0001). Among the two techniques, only "unattended" systolic BP showed a significant association with left ventricular mass ( = 0.11; = .40 for "attended" BP; = 0.27; = .036 for unattended BP; difference between slopes: = 3.92; = .0001).
In RA patients, "unattended" BP is lower than traditional ("attended") BP and more closely associated with LV mass. In these patients, the "unattended" automated BP measurement is a promising tool which requires further evaluation.KEY MESSAGES"Unattended" automated blood pressure registration, aimed to reduce the "white-coat effect" is lower than "attended" value in rheumatoid arthritis patients."Unattended" blood pressure is more closely associated with left ventricular mass than "attende" registration.
高血压在类风湿关节炎（RA）患者中普遍存在，知晓率和控制率低。正确测量血压在这些患者中非常重要。“非诊室”血压测量旨在降低与心血管风险相关的“白大衣效应”。RA 患者“非诊室”血压测量及其对高血压器官损害影响的数据非常有限。
采用随机交叉设计，对同一患者进行传统测量（“诊室”血压）和“非诊室”方案（3 次自动诊室血压测量，间隔 1 分钟，休息 5 分钟后，患者独处）。患者接受临床检查、12 导联心电图和经胸超声心动图检查，以评估心脏损伤。
共纳入 62 例 RA 患者（平均年龄 67±9 岁，87%为女性）。根据 ACC/AHA 和 ESC/ESH 标准，分别有 79%和 66%的患者诊断为高血压。两种技术之间的一致性相关系数分别为收缩压 0.55（95%CI 0.38-0.68）和舒张压 0.73（95%CI 0.60-0.82）。“非诊室”（121.7/68.6mmHg）血压低于“诊室”血压（130.5/72.8mmHg）（均<0.0001）。两种技术中，只有“非诊室”收缩压与左心室质量呈显著相关（=0.11；“诊室”血压为=0.40；=0.27；“非诊室”血压为=0.036；斜率差值：=3.92；=0.0001）。
在 RA 患者中，“非诊室”血压低于传统（“诊室”）血压，与 LV 质量更为密切相关。在这些患者中，“非诊室”自动血压测量是一种很有前途的工具，需要进一步评估。
旨在降低“白大衣效应”的“非诊室”自动血压登记低于 RA 患者的“诊室”血压值。“非诊室”血压与左心室质量的相关性强于“诊室”血压登记。
