University of Alabama at Birmingham, Birmingham, Alabama.
Duke University, Durham, North Carolina.
J Hypertens. 2022 Aug 1;40(8):1597-1606. doi: 10.1097/HJH.0000000000003192. Epub 2022 Jul 5.
Compared with the Seventh Report of the Joint National Committee (JNC7), the 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline uses lower BP thresholds to define hypertension and BP control.
We pooled data from five US-based studies to compare the association of masked hypertension (MHT) and masked uncontrolled hypertension, defined using the 2017 ACC/AHA guideline ( n = 1653 without high office BP; <130/80 mmHg) versus the JNC7 guideline ( n = 2451 without high office BP; <140/90 mmHg), with left ventricular hypertrophy (LVH). MHT and masked uncontrolled hypertension were defined using office BP and awake BP alone and awake, asleep, or 24-h BP. LVH was assessed by echocardiography.
Among participants without high office BP not taking antihypertensive medication, the prevalence of MHT defined by the JNC7 guideline and the 2017 ACC/AHA BP guideline was 25.0 and 33.5% using awake BP only and 37.1 and 52.0% when using awake, asleep, or 24-h BP. The adjusted prevalence ratios for LVH associated with MHT versus sustained normotension defined by the JNC7 and 2017 ACC/AHA BP guidelines were 1.72 [95% confidence interval (CI): 1.12-2.64] and 1.56 (95% CI: 0.97-2.51), respectively, when using awake BP only and 2.16 (95% CI: 1.36-3.44) and 1.03 (95% CI: 0.58-1.82), respectively, when using awake, asleep or 24-h BP. There was no evidence that masked uncontrolled hypertension was associated with LVH when defined using the BP thresholds in either the JNC7 or the 2017 ACC/AHA BP guideline.
The association of MHT with LVH may depend on the BP thresholds used.
与第七次联合国家委员会报告（JNC7）相比，2017 年美国心脏病学会/美国心脏协会（ACC/AHA）血压（BP）指南使用更低的 BP 阈值来定义高血压和 BP 控制。
我们汇总了来自五个基于美国的研究数据，以比较使用 2017 年 ACC/AHA 指南（n=1653 例无高诊室 BP；<130/80mmHg）和 JNC7 指南（n=2451 例无高诊室 BP；<140/90mmHg）定义的隐匿性高血压（MHT）和隐匿性未控制高血压与左心室肥厚（LVH）之间的关联。使用诊室 BP 和清醒时 BP 单独以及清醒时、睡眠时或 24 小时 BP 定义 MHT 和隐匿性未控制高血压。通过超声心动图评估 LVH。
在未服用降压药物且无高诊室 BP 的参与者中，使用 JNC7 指南和 2017 年 ACC/AHA BP 指南定义的 MHT 分别占清醒时 BP 单独的 25.0%和 33.5%，占清醒时、睡眠时或 24 小时 BP 的 37.1%和 52.0%。与 JNC7 和 2017 年 ACC/AHA BP 指南定义的持续正常血压相比，MHT 与 LVH 的调整比值比分别为 1.72（95%可信区间：1.12-2.64）和 1.56（95%可信区间：0.97-2.51），当仅使用清醒时 BP 时，分别为 2.16（95%可信区间：1.36-3.44）和 1.03（95%可信区间：0.58-1.82）。当使用清醒时、睡眠时或 24 小时 BP 时，没有证据表明隐匿性未控制高血压与 LVH 相关。
MHT 与 LVH 的关联可能取决于使用的 BP 阈值。
