Seo Jiwon, Lee Chan Joo, Kim Dae-Hee, Kim Song-Yi, Moon Jae Youn, Park Jae-Hyeong, Son Jang-Won, Kim Jang Young, Kim In-Cheol, Rhee Moo-Yong, Lee Ju-Hee, Lee Hae-Young, Chung Joong-Wha, Ihm Sang-Hyun, Choi Jung Hyun, Shin Jinho, Park Sungha
Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Hypertens Res. 2025 Jan;48(1):37-48. doi: 10.1038/s41440-024-02017-7. Epub 2024 Nov 14.
This study aimed to investigate the characteristics of out-of-office blood pressure (BP) measurements in patients with apparent treatment-resistant hypertension (aRH) enrolled from 15 tertiary care centers in South Korea. aRH was defined as having uncontrolled office BP ≥ 130/80 mmHg despite receiving three classes of antihypertensive medication or any level of BP despite receiving ≥4 classes of antihypertensive medication. Patients with complete data for office BP, 24-h ambulatory BP monitoring (ABPM), and home BP measurements at baseline were included. BP control status between ABPM and home BP measurements was compared. Out of 1457 patients, 823 meeting the enrollment criteria were included (mean age: 59.9 ± 13.6 years; 57.5% male patients). Among them, 7.2% had controlled BP, 8.7% had whitecoat uncontrolled hypertension, 15.1% had masked uncontrolled hypertension, and 69% had sustained hypertension, as measured through baseline ABPM. Additionally, 43% of patients with controlled BP based on home BP measurement had nocturnal hypertension. Relying solely on home BP measurement may result in misclassifying 70% of patients as having either controlled BP or whitecoat uncontrolled BP. This study reaffirms the circadian pattern of resistant hypertension, characterized by a higher prevalence of non-dipping and rising patterns, even in patients with BP controlled based on ABPM. Considering the persistent difference between home BP measurement and ABPM, even at a lower home BP threshold, integrating both measurements into the management of aRH is advisable.
本研究旨在调查从韩国15家三级医疗中心招募的貌似难治性高血压（aRH）患者的诊室外血压（BP）测量特征。aRH的定义为，尽管接受了三类抗高血压药物治疗，但诊室血压仍≥130/80 mmHg且未得到控制，或者尽管接受了≥4类抗高血压药物治疗，但血压处于任何水平。纳入了在基线时具有完整诊室血压、24小时动态血压监测（ABPM）和家庭血压测量数据的患者。比较了ABPM和家庭血压测量之间的血压控制状态。在1457例患者中，823例符合纳入标准（平均年龄：59.9±13.6岁；男性患者占57.5%）。其中，通过基线ABPM测量，7.2%的患者血压得到控制，8.7%的患者为白大衣未控制高血压，15.1%的患者为隐匿性未控制高血压，69%的患者为持续性高血压。此外，根据家庭血压测量血压得到控制的患者中，43%有夜间高血压。仅依靠家庭血压测量可能会导致70%的患者被错误分类为血压得到控制或白大衣未控制血压。本研究再次证实了难治性高血压的昼夜模式，其特征是非勺型和上升型模式的患病率较高，即使是根据ABPM血压得到控制的患者也是如此。考虑到家庭血压测量和ABPM之间的持续差异，即使在较低的家庭血压阈值下，将这两种测量方法纳入aRH的管理中也是可取的。
