Chotruangnapa Chavalit, Thammarux Tossaporn, Thongdang Piyawan
Division of Hypertension, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Int J Hypertens. 2022 Dec 8;2022:6912839. doi: 10.1155/2022/6912839. eCollection 2022.
Quality and quantity of home blood pressure (BP) control are important for optimizing hypertensive treatment. The prevalence and associated clinical characteristics of the different home blood pressure phenotypes in treated hypertensive patients were not elucidated. This study was conducted in Siriraj Hospital, Thailand from 2019 to 2020. We included treated hypertensive patients with ≥1 antihypertensive drug and had self-home BP measurement data. Both traditional (office BP < 140/90 mmHg and home BP < 130/80 mmHg) and new BP targets (office and home BP < 130/80 mmHg) were used for the classification of BP phenotypes. Home BP phenotypes consisted of controlled hypertension (all home BPs achieved home BP targets), isolated uncontrolled morning hypertension (MoHT) (only morning BP was above home BP targets), isolated uncontrolled evening hypertension (EHT) (only evening BP was above home BP targets), and combined morning-evening uncontrolled hypertension (MoEHT) (all home BPs were above home BP targets). Our study included 1,406 patients. The total mean age was 62.94 ± 13.97 years. There were 39.40% men. The prevalence of each home BP phenotype (by traditional BP target) was 55.76%, 12.66%, 7.40%, and 24.18% in controlled (home) hypertension, MoHT, EHT, and MoEHT, respectively. Classical BP control status was 35.21% well-controlled hypertension, 30.01% white-coat uncontrolled hypertension, 9.74% masked uncontrolled hypertension, and 25.04% sustained uncontrolled hypertension. The multivariable analysis showed the significantly associated factor of MoHT was the presence of previous cardiovascular disease (adjusted OR 5.54, 95% CI (2.02-15.22); value = 0.001). Taking once-daily long-acting antihypertensive drugs in the morning were significantly associated with both EHT (adjusted OR 0.20, 95% CI (0.05-0.82); value = 0.025) and MoEHT (adjusted OR 0.20, 95% CI (0.04-1.00); value = 0.049). These results were consistent in groups classified by new home BP target <130/80 mmHg.
家庭血压（BP）控制的质量和数量对于优化高血压治疗至关重要。在接受治疗的高血压患者中，不同家庭血压表型的患病率及相关临床特征尚未明确。本研究于2019年至2020年在泰国诗里拉吉医院进行。我们纳入了使用≥1种抗高血压药物且有家庭自测血压数据的高血压患者。传统血压目标（诊室血压<140/90 mmHg且家庭血压<130/80 mmHg）和新血压目标（诊室和家庭血压<130/80 mmHg）均用于血压表型分类。家庭血压表型包括血压控制良好的高血压（所有家庭血压均达到家庭血压目标）、单纯清晨血压未控制的高血压（MoHT）（仅清晨血压高于家庭血压目标）、单纯夜间血压未控制的高血压（EHT）（仅夜间血压高于家庭血压目标）以及清晨和夜间血压均未控制的高血压（MoEHT）（所有家庭血压均高于家庭血压目标）。我们的研究纳入了1406例患者。总平均年龄为62.94±13.97岁。男性占39.40%。按照传统血压目标，各家庭血压表型在血压控制良好的（家庭）高血压、MoHT、EHT和MoEHT中的患病率分别为55.76%、12.66%、7.40%和24.18%。经典血压控制状态为血压控制良好的高血压占35.21%、白大衣性未控制高血压占30.01%、隐匿性未控制高血压占9.74%以及持续性未控制高血压占25.04%。多变量分析显示，MoHT的显著相关因素是既往有心血管疾病（调整后的OR为5.54，95%CI（2.02 - 15.22）；P值 = 0.001）。清晨服用每日一次长效抗高血压药物与EHT（调整后的OR为0.20，95%CI（0.05 - 0.82）；P值 = 0.025）和MoEHT（调整后的OR为0.20，95%CI（0.04 - 1.00）；P值 = 0.049）均显著相关。在按照家庭血压新目标<130/80 mmHg分类的组中，这些结果是一致的。
