隐蔽性未控制高血压的影响因素
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摘要
目的探讨隐蔽性未控制高血压(MUCH)的检出率及危险因素。方法以正在服用抗高血压药且接受了24h动态血压监测(24hABPM)的诊室血压达标人群作为观察对象。根据24hABPM是否达标将研究对象分为两组:高血压已控制(CH)组和MUCH组。采用逐步Logistic回归模型分析影响MUCH的危险因素。结果在有合格诊室血压及24hABPM数据的1815例患者中,诊室血压达标者482例(26.6%)。482例患者平均年龄为55.6岁,含男性363例(77.7%),其中CH组131例,占27.2%;MUCH组351例,占72.8%。逐步Logistic回归模型分析显示,吸烟、高体质量指数(BMI)和高诊室舒张压是影响MUCH的危险因素,OR(95%CI)分别为2.00(1.09~3.67)、2.54(1.50~4.29)和1.08(1.03~1.12)。结论约3/4诊室血压达标的高血压患者24hABPM不达标。高BMI、高诊室舒张压、吸烟是影响MUCH的独立危险因素。
Objective To explore the prevalence and risk factors of masked uncontrolled hypertension(MUCH).Methods Patients whose office blood pressure were controlled and who underwent 24-hour ambulatory blood pressure monitoring(24 hABPM)were included in the study. According to 24 hblood pressure,patients were divided into 2 groups:controlled hypertension(CH)group and MUCH group. Stepwise Logistic regression model was used to analyze the risk factors associated with MUCH. Results Of the 1815 patients who had both valid office blood pressure and 24 hABPM,482(26.6%)had their office blood pressure controlled. Among those 482 patients[average age 55.6 years old,and 363(77.7%)were males],131 cases(27.2%)were in the CH group,and 351 cases in the MUCH group(72.8%). Stepwise Logistic regression analysis showed that smoking,higher body mass index(BMI)and higher office diastolic blood pressure(DBP)were the risk factors for MUCH. The odds ratios(95% CI)were 2.00(1.09-3.67),2.54(1.50-4.29)and 1.08(1.03-1.12),respectively. Conclusion About 3/4 of patients with controlled office blood pressure had uncontrolled 24 hambulatory blood pressure.Smoking,higher BMI and higher office DBP were the risk factors of MUCH.
Objective To explore the prevalence and risk factors of masked uncontrolled hypertension(MUCH).Methods Patients whose office blood pressure were controlled and who underwent 24-hour ambulatory blood pressure monitoring(24 hABPM)were included in the study. According to 24 hblood pressure,patients were divided into 2 groups:controlled hypertension(CH)group and MUCH group. Stepwise Logistic regression model was used to analyze the risk factors associated with MUCH. Results Of the 1815 patients who had both valid office blood pressure and 24 hABPM,482(26.6%)had their office blood pressure controlled. Among those 482 patients[average age 55.6 years old,and 363(77.7%)were males],131 cases(27.2%)were in the CH group,and 351 cases in the MUCH group(72.8%). Stepwise Logistic regression analysis showed that smoking,higher body mass index(BMI)and higher office diastolic blood pressure(DBP)were the risk factors for MUCH. The odds ratios(95% CI)were 2.00(1.09-3.67),2.54(1.50-4.29)and 1.08(1.03-1.12),respectively. Conclusion About 3/4 of patients with controlled office blood pressure had uncontrolled 24 hambulatory blood pressure.Smoking,higher BMI and higher office DBP were the risk factors of MUCH.
引文
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[16]Kikuya M,Hansen TW,Thijs L,et al.Diagnostic thresholds for ambulatory blood pressure monitoring based on 10-year cardiovascular risk[J].Circulation,2007,115(16):2145-2152.
[17]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.
[18]王文,张维忠,孙宁玲,等.中国血压测量指南[J].中华高血压杂志,2011,19(12):1101-1115.
[19] Vinyoles E,Camafort M,Domenech M,et al.Prevalence of masked uncontrolled hypertension according to the number of office blood pressure measurements[J].Rev Clin Esp,2015,215(8):425-430.
[20]Leiria LF,Severo MD,Ledur PS,et al.White coat effect and masked uncontrolled hypertension in treated hypertensive-diabetic patients:prevalence and target organ damage[J].J Diabetes,2015,7(5):699-707.
[21]Schultz MG,Hare JL,Marwick TH,et al.Masked hypertension is"unmasked"by low-intensity exercise blood pressure[J].Blood Press,2011,20(5):284-289.
[22]Rognant N,Lemoine S,Laville M,et al.Performance of the chronic kidney disease epidemiology collaboration equation to estimateglomerular filtration rate in diabetic patients[J].Diabetes Care,2011,34(6):1320-1322.
[23]郑晓明,李志芳,吴云涛,等.老年人群立位肱-踝脉搏波传导速度和踝臂指数的影响因素分析[J].中华心血管病杂志,2016,24(2):161-169.
[24]Pogue V,Rahman M,Lipkowitz M,et al.Disparate estimates of hypertension control from ambulatory and clinic blood pressure measurements in hypertensive kidney disease[J].Hypertension,2009,53(1):20-27.
[25]Naser N,Dzubur A,Durak A,et al.Blood pressure control in hypertensive patients,cardiovascular risk profile and the prevalence of masked uncontrolled hypertension(MUCH)[J].Med Arch,2016,70(4):274-279.
[26]Rasmussen SL,Torp-Pedersen C,Borch-Johnsen K,et al.Normal values for ambulatory blood pressure and differences between casual blood pressure and ambulatory blood pressure:results from a Danish population survey[J].J Hypertens,1998,16(10):1415-1424.
[27]Schwartz JE,Burg MM,Shimbo D,et al.Clinic blood pressure underestimates ambulatory blood pressure in an untreated employer-based US population:results from the masked hypertension study[J].Circulation,2016,134(23):1794-1807.
[28]Divison-Garrote JA,Ruilope LM,de la Sierra A,et al.Magnitude of hypotension based on office and ambulatory blood pressure monitoring:results from a cohort of 5066treated hypertensive patients aged 80years and older[J].J Am Med Dir Assoc,2017,18(5):452.e1-452.e6.
[29]吴寿岭,张冬艳,刘运秋,等.睡眠呼吸暂停综合征与隐蔽性高血压[J].中华高血压杂志,2008,16(4):354-357.
[30]Young T,Peppard PE,Gottlieb DJ.Epidemiology of obstructive sleep apnea:apopulation health perspective[J].Am J Respir Crit Care Med,2002,165(9):1217-1239.
[31]Pratt-Ubunama MN,Nishizaka MK,Boedefeld RL,et al.Plasma aldosterone is related to severity of obstructive sleep apnea in subjects with resistant hypertension[J].Chest,2007,131(2):453-459.
[32]Grassi G,Seravalle G,Trevano FQ,et al.Neurogenic abnormalities in masked hypertension[J].Hypertension,2007,50(3):537-542.
[33]Sabater-Hernández D,Sendra-Lillo J,Jiménez-Monleón JJ,et al.Identifying masked uncontrolled hypertension in the community pharmacy setting[J].Blood Press Monit,2015,20(3):138-143.
[34]Krause T,Lovibond K,Caulfield M,et al.Management of hypertension:summary of NICE guidance[J].BMJ,2011,343:d4891.
[35]中国高血压联盟,中国医师协会高血压专业委员会血压测量与监测工作委员会,《中华高血压杂志》编委会.动态血压监测临床应用中国专家共识[J].中华高血压杂志,2015,23(8):727-730.
[2]Muntner P,Davis BR,Cushman WC,et al.Treatment-resistant hypertension and the incidence of cardiovascular disease and endstage renal disease:results from the antihypertensive and lipidlowering treatment to prevent heart attack trial(ALLHAT)[J].Hypertension,2014,64(5):1012-1021.
[3]O’Donnell MJ,Xavier D,Liu L,et al.Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries(the INTERSTROKE study):a case-control study[J].Lancet,2010,376(9735):112-123.
[4]Triantafyllou A,Anyfanti P,Zabulis X,et al.Accumulation of microvascular target organ damage in newly diagnosed hypertensive patients[J].J Am Soc Hypertens,2014,8(8):542-549.
[5]国家卫计委疾病预防控制局.中国居民营养与慢性病状况报告(2015年)[M].北京:人民卫生出版社,2016.
[6]Franklin SS,O’Brien E,Thijs L,et al.Masked hypertension:a phenomenon of measurement[J].Hypertension,2015,65(1):16-20.
[7]Tomiyama M,Horio T,Yoshii M,et al.Masked hypertension and target organ damage in treated hypertensive patients[J].Am J Hypertens,2006,19(9):880-886.
[8]Banegas JR,Ruilope LM,Sierra Adl,et al.Relationship between clinic and ambulatory blood-pressure measurements and mortality[J].N Engl J Med,2018,378(16):1509-1520.
[9]Pierdomenico SD,Lapenna D,Bucci A,et al.Cardiovascular outcome in treated hypertensive patients with responder,masked,false resistant,and true resistant hypertension[J].Am J Hypertens,2005,18(11):1422-1428.
[10]Andalib A,Akhtari S,Rigal R,et al.Determinants of masked hypertension in hypertensive patients treated in aprimary care setting[J].Intern Med J,2012,42(3):260-266.
[11]Mallion JM,Clerson P,Bobrie G,et al.Predictive factors for masked hypertension within a population of controlled hypertensives[J].J Hypertens,2006,24(12):2365-2370.
[12]姚涛,董岩,李占杰,等.老年高血压患者诊室血压和动态血压达标情况分析[J].中华高血压杂志,2015,23(12):1145-1150.
[13]Banegas JR,Ruilope LM,de la Sierra A,et al.High prevalence of masked uncontrolled hypertension in people with treated hypertension[J].Eur Heart J,2014,35(46):3304-3312.
[14]Kang YY,Li Y,Huang QF,et al.Accuracy of home versus ambulatory blood pressure monitoring in the diagnosis of white-coat and masked hypertension[J].J Hypertens,2015,33(8):1580-1587.
[15]Wu SL,Huang ZR,Yang XC,et al.Prevalence of ideal cardiovascular health and its relationship with the 4-year cardiovascular events in a Northern Chinese industrial city[J].Circ Cardiovasc Qual Outcomes,2012,5(4):487-493.
[16]Kikuya M,Hansen TW,Thijs L,et al.Diagnostic thresholds for ambulatory blood pressure monitoring based on 10-year cardiovascular risk[J].Circulation,2007,115(16):2145-2152.
[17]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.
[18]王文,张维忠,孙宁玲,等.中国血压测量指南[J].中华高血压杂志,2011,19(12):1101-1115.
[19] Vinyoles E,Camafort M,Domenech M,et al.Prevalence of masked uncontrolled hypertension according to the number of office blood pressure measurements[J].Rev Clin Esp,2015,215(8):425-430.
[20]Leiria LF,Severo MD,Ledur PS,et al.White coat effect and masked uncontrolled hypertension in treated hypertensive-diabetic patients:prevalence and target organ damage[J].J Diabetes,2015,7(5):699-707.
[21]Schultz MG,Hare JL,Marwick TH,et al.Masked hypertension is"unmasked"by low-intensity exercise blood pressure[J].Blood Press,2011,20(5):284-289.
[22]Rognant N,Lemoine S,Laville M,et al.Performance of the chronic kidney disease epidemiology collaboration equation to estimateglomerular filtration rate in diabetic patients[J].Diabetes Care,2011,34(6):1320-1322.
[23]郑晓明,李志芳,吴云涛,等.老年人群立位肱-踝脉搏波传导速度和踝臂指数的影响因素分析[J].中华心血管病杂志,2016,24(2):161-169.
[24]Pogue V,Rahman M,Lipkowitz M,et al.Disparate estimates of hypertension control from ambulatory and clinic blood pressure measurements in hypertensive kidney disease[J].Hypertension,2009,53(1):20-27.
[25]Naser N,Dzubur A,Durak A,et al.Blood pressure control in hypertensive patients,cardiovascular risk profile and the prevalence of masked uncontrolled hypertension(MUCH)[J].Med Arch,2016,70(4):274-279.
[26]Rasmussen SL,Torp-Pedersen C,Borch-Johnsen K,et al.Normal values for ambulatory blood pressure and differences between casual blood pressure and ambulatory blood pressure:results from a Danish population survey[J].J Hypertens,1998,16(10):1415-1424.
[27]Schwartz JE,Burg MM,Shimbo D,et al.Clinic blood pressure underestimates ambulatory blood pressure in an untreated employer-based US population:results from the masked hypertension study[J].Circulation,2016,134(23):1794-1807.
[28]Divison-Garrote JA,Ruilope LM,de la Sierra A,et al.Magnitude of hypotension based on office and ambulatory blood pressure monitoring:results from a cohort of 5066treated hypertensive patients aged 80years and older[J].J Am Med Dir Assoc,2017,18(5):452.e1-452.e6.
[29]吴寿岭,张冬艳,刘运秋,等.睡眠呼吸暂停综合征与隐蔽性高血压[J].中华高血压杂志,2008,16(4):354-357.
[30]Young T,Peppard PE,Gottlieb DJ.Epidemiology of obstructive sleep apnea:apopulation health perspective[J].Am J Respir Crit Care Med,2002,165(9):1217-1239.
[31]Pratt-Ubunama MN,Nishizaka MK,Boedefeld RL,et al.Plasma aldosterone is related to severity of obstructive sleep apnea in subjects with resistant hypertension[J].Chest,2007,131(2):453-459.
[32]Grassi G,Seravalle G,Trevano FQ,et al.Neurogenic abnormalities in masked hypertension[J].Hypertension,2007,50(3):537-542.
[33]Sabater-Hernández D,Sendra-Lillo J,Jiménez-Monleón JJ,et al.Identifying masked uncontrolled hypertension in the community pharmacy setting[J].Blood Press Monit,2015,20(3):138-143.
[34]Krause T,Lovibond K,Caulfield M,et al.Management of hypertension:summary of NICE guidance[J].BMJ,2011,343:d4891.
[35]中国高血压联盟,中国医师协会高血压专业委员会血压测量与监测工作委员会,《中华高血压杂志》编委会.动态血压监测临床应用中国专家共识[J].中华高血压杂志,2015,23(8):727-730.