心血管病高危人群依据白天、夜间、24 h动态血压诊断的隐匿性高血压的特征分析

Characteristics Analysis of Masked Hypertension Diagnosed by Daytime,Nighttime,and 24-Hour Ambulatory Blood Pressure in People with High Cardiovascular Disease Risk

目的探索在同一人群中,依据白天、夜间和24 h平均动态血压隐匿性高血压(masked hypertension,MH)的检出率有无差别以及患者临床特征是否存在差异。方法对2017年3月至2018年7月东莞市寮步镇262例诊室血压均值<140/90 mmHg(1 mmHg=0.133 kPa)且无原发性高血压(高血压)史的心血管病高危对象进行动态血压监测(ambulatory blood pressure monitoring,ABPM),分别以(1)24 h平均值≥130/80 mmHg;(2)白天均值≥135/85 mmHg;(3)夜间均值≥120/70 mmHg为标准诊断MH,计算相应检出率和一致性,并比较单纯夜间、单纯白天、24 h/白天+夜间MH对象的基本特征、血压、生化和超声结果。结果依据白天、夜间和24 h血压MH的检出率分别为32.8%、47.7%和28.6%,而以任一时段血压水平诊断的MH患者为148例(56.5%)。采用24 h和白天血压指标诊断的MH结果较为一致(Kappa=0.687,P<0.001),与用夜间血压指标诊断的MH差异较大。持续性MH组(占全部MH的57.4%)诊室收缩压值(F=11.414,P<0.001)和清晨高血压比例高于另两组(χ^(2)=39.626,P<0.001)。单纯白天MH组(占8.8%)的超杓型比例更高,单纯夜间MH组(占33.8%)的反杓型比例高。结论采用ABPM不同时段的血压水平诊断的MH检出率有不同,不同MH亚组患者的诊室收缩压和血压昼夜节律也有不同。

Objectives To explore the differences in the detection rate of masked hypertension(MH)diagnosed by mean ambulatory blood pressure during daytime,nighttime and 24-hour and the clinical characteristics of patients with MH in the same population.Methods ABPM was performed on 262 patients with high cardiovascular disease risk from March 2017 to July 2018 in Dongguan Liaobu,with clinic blood pressure<140/90 mmHg(1 mmHg=0.133 kPa)and no history of hypertension.MH was diagnosied by the standard of 24 h mean ambulatory blood pressure≥130/80 mmHg,the daytime mean ambulatory blood pressure≥135/85 mmHg and the nighttime mean ambulatory blood pressure≥120/70 mmHg.The detection rates and consistency were calculated.The basic characteristics,blood pressure,biochemical and ultrasonic results of the detected objects of isolated nighttime MH,isolated daytime MH and sustained MH were compared.Results The detection rates of MH patients were 32.8%,47.7%and 28.6%based on daytime,nighttime and 24-hour blood pressure alone.There were 148 patients(56.5%)with high blood pressure at any time were diagnosed with MH.The diagnosis results of 24 h and daytime ambulatory blood pressure were consistent(Kappa=0.687,P<0.001),and there was a great difference from the diagnosis of nighttime.The level of systolic blood pressure(F=11.414,P<0.001)and the proportion of morning hypertension(χ^(2)=39.626,P<0.001)in sustained MH group which accounts for 57.4%of all the MH was higher than that in the other two groups(P<0.05).The proportion of supper-dipper was higher in isolated daytime MH group(8.8%),and the proportion of reverse-dipper was higher in isolated nighttime MH group(33.8%).Conclusions There were differences in the detection rate of MH patients diagnosed with different ABPM periods,and differences in the office systolic blood pressure and circadian rhythm among the three MH subgroups.