Department of Family Medicine.
Department of Social Sciences, Semmelweis University.
J Hypertens. 2024 Nov 1;42(11):1976-1984. doi: 10.1097/HJH.0000000000003825. Epub 2024 Jul 29.
Blood pressure (BP) lowering therapy in hypertension can markedly reduce the risk of cardiovascular diseases. In case of high-normal office blood pressure (oBP), the initiation of antihypertensive medication is recommended by guidelines in patients with very high cardiovascular risk. The aims of this study were to evaluate the presence of white-coat high-normal BP (WhHNBP) and masked hypertension in high-normal oBP and to explore the prevalence of untreated very high cardiovascular risk patients.
Data of the Hungarian Ambulatory Blood Pressure Monitoring (ABPM) Registry between September 2020 and November 2023 were used in our analysis.
From 38 720 uploaded ABPM curves with clinical data, 4300 individuals were categorized as having high-normal oBP. Among those, 3285 (76.4%) were on antihypertensive treatment. Based on the ABPM recordings, high-normal BP was confirmed in 20.5% ( n = 881), while WhHNBP was present in 27.6% ( n = 1188) and masked hypertension in 51.9% ( n = 2231). Similar results were found in treated and untreated subjects or patients as well. Independent predictors of WhHNBP were age [odds ratio (OR) 1.02 (95% confidence interval, 95% CI: 1.01-1.02), P < 0.001], female sex [OR: 1.59 (1.32-1.92), P < 0.001] and snoring [OR: 0.70 (0.57-0.86), P < 0.001]. Independent predictors of masked hypertension were male sex [OR: 1.31 (1.12-1.54), P < 0.001] and obesity [OR: 1.71 (1.39-2.09), P < 0.001]. Five hundred and two individuals had very high cardiovascular risk with high-normal oBP and only 25 of them were untreated.
In high-normal oBP, WhHNBP or masked hypertension is present in three out of four individuals. Most of the patients with high-normal oBP and very high cardiovascular risk are already treated with antihypertensive drugs.
高血压患者的降压治疗可显著降低心血管疾病风险。对于高正常诊室血压（oBP），指南建议心血管风险极高的患者开始使用降压药物。本研究旨在评估高正常 oBP 中白大衣性高正常血压（WhHNBP）和隐匿性高血压的存在情况，并探讨未经治疗的极高心血管风险患者的患病率。
本研究使用了 2020 年 9 月至 2023 年 11 月间匈牙利动态血压监测（ABPM）登记处的数据。
在 38720 份上传的包含临床数据的 ABPM 曲线中，4300 名个体被归类为高正常 oBP。其中，3285 名（76.4%）正在接受降压治疗。根据 ABPM 记录，高正常 BP 得到确认的占 20.5%（n=881），而 WhHNBP 存在的占 27.6%（n=1188），隐匿性高血压的占 51.9%（n=2231）。在接受治疗和未接受治疗的患者或个体中也发现了类似的结果。WhHNBP 的独立预测因素为年龄[比值比（OR）1.02（95%置信区间，95%CI：1.01-1.02），P<0.001]、女性[OR：1.59（1.32-1.92），P<0.001]和打鼾[OR：0.70（0.57-0.86），P<0.001]。隐匿性高血压的独立预测因素为男性[OR：1.31（1.12-1.54），P<0.001]和肥胖[OR：1.71（1.39-2.09），P<0.001]。502 名高正常 oBP 且具有极高心血管风险的个体中，仅有 25 名未接受治疗。
在高正常 oBP 中，WhHNBP 或隐匿性高血压在四分之三的个体中存在。大多数高正常 oBP 且具有极高心血管风险的患者已接受降压药物治疗。
