Prognosis of White-Coat and Masked Hypertension International Database of Home Blood Pressure in Relation to Cardiovascular Outcome

被引:242
作者
Stergiou, George S. [1 ]
Asayama, Kei [2 ,3 ]
Thijs, Lutgarde [2 ]
Kollias, Anastasios [1 ]
Niiranen, Teemu J. [4 ,5 ]
Hozawa, Atsushi [6 ]
Boggia, Jose [7 ,8 ]
Johansson, Jouni K. [4 ]
Ohkubo, Takayoshi [3 ]
Tsuji, Ichiro [9 ]
Jula, Antti M. [4 ]
Imai, Yutaka [3 ]
Staessen, Jan A. [2 ,10 ]
机构
[1] Sotiria Hosp, Univ Dept Med 3, Hypertens Ctr, Athens, Greece
[2] Univ Louvain, KU Leuven Dept Cardiovasc Sci, Res Unit Hypertens & Cardiovasc Epidemiol, Studies Coordinating Ctr, BE-3000 Louvain, Belgium
[3] Tohoku Univ, Dept Planning Drug Dev & Clin Evaluat, Grad Sch Pharmaceut Sci, Sendai, Miyagi 980, Japan
[4] Natl Inst Hlth & Welf, Dept Chron Dis Prevent, Populat Studies Unit, Turku, Finland
[5] Turku Univ Hosp, Dept Med, Turku, Finland
[6] Tohoku Univ, Tohoku Med Megabank Org, Dept Prevent Med & Epidemiol, Sendai, Miyagi 980, Japan
[7] Univ Republica, Hosp Clin, Ctr Nefrol, Montevideo, Uruguay
[8] Univ Republica, Hosp Clin, Dept Fisiopatol, Montevideo, Uruguay
[9] Tohoku Univ, Grad Sch Med, Dept Publ Hlth, Sendai, Miyagi 980, Japan
[10] Maastricht Univ, Dept Epidemiol, Maastricht, Netherlands
基金
欧洲研究理事会;
关键词
cardiovascular diseases; home blood pressure monitoring; masked hypertension; meta-analysis; prognosis; white-coat hypertension; EUROPEAN-SOCIETY; GENERAL-POPULATION; SELF-MEASUREMENT; STROKE RISK; METAANALYSIS; OHASAMA; OFFICE; PREDICTION; TERM; INDIVIDUALS;
D O I
10.1161/HYPERTENSIONAHA.113.02741
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
Home blood pressure monitoring is useful in detecting white-coat and masked hypertension and is recommended for patients with suspected or treated hypertension. The prognostic significance of white-coat and masked hypertension detected by home measurement was investigated in 6458 participants from 5 populations enrolled in the International Database of HOme blood pressure in relation to Cardiovascular Outcomes. During a median follow-up of 8.3 years, 714 fatal plus nonfatal cardiovascular events occurred. Among untreated subjects (n=5007), cardiovascular risk was higher in those with white-coat hypertension (adjusted hazard ratio 1.42; 95% CI [1.06-1.91]; P=0.02), masked hypertension (1.55; 95% CI [1.12-2.14]; P<0.01) and sustained hypertension (2.13; 95% CI [1.66-2.73]; P<0.0001) compared with normotensive subjects. Among treated patients (n=1451), the cardiovascular risk did not differ between those with high office and low home blood pressure (white-coat) and treated controlled subjects (low office and home blood pressure; 1.16; 95% CI [0.79-1.72]; P=0.45). However, treated subjects with masked hypertension (low office and high home blood pressure; 1.76; 95% CI [1.23-2.53]; P=0.002) and uncontrolled hypertension (high office and home blood pressure; 1.40; 95% CI [1.02-1.94]; P=0.04) had higher cardiovascular risk than treated controlled patients. In conclusion, white-coat hypertension assessed by home measurements is a cardiovascular risk factor in untreated but not in treated subjects probably because the latter receive effective treatment on the basis of their elevated office blood pressure. In contrast, masked uncontrolled hypertension is associated with increased cardiovascular risk in both untreated and treated patients, who are probably undertreated because of their low office blood pressure.
引用
收藏
页码:675 / 682
页数:8
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