ABSTRACT

We report the analysis of 252 hypertensive patients whose blood pressure (BP) was assessed by around-the-clock ambulatory BP monitoring compared to office BP measurement during a follow-up investigation of 8.7 y (SD: 2.43 y) that evaluated the added value of measuring sleep-time BP values. We found that 37.3% of the patients had mismatched diagnoses between the two techniques of BP assessment, with 11.5% of the patients showing white-coat hypertension and 25.8% masked hypertension. Only 12.3% of the diagnosed and treated patients presented normal BP values. Nocturnal (sleep-time) hypertension was present in 70.63%. The sleep-time systolic BP mean was found to be an independent vascular risk factor (F = 9.005, p < .001), indirectly measured through the 10-year risk of morbidity and mortality. Additionally, the elevated sleep-time systolic BP mean was a better marker of subclinical hypertension-mediated organ damage (ρ = 0.19, p < .01) than either the awake (ρ = 0.168, p < .01) or 24 (ρ = 0.184, p < .01) systolic BP means. In conclusion, the accuracy and sleep-time measurements provided by ambulatory BP make it particularly relevant in hypertension diagnosis and management. The use of the ambulatory BP measurement method could end up modifying current therapeutic targets, with sleep-time systolic BP mean becoming a main one, in order to optimize hypertension control and reduce hypertension-related organ pathology and cardiovascular disease morbidity and mortality.

摘要

我们报告了对 252 名高血压患者的分析，这些患者在 8.7 年（标准差：2.43 年）的随访调查期间通过全天候动态血压监测评估了血压 (BP)，并评估了附加值测量睡眠时血压值。我们发现 37.3% 的患者在两种血压评估技术之间的诊断不匹配，其中 11.5% 的患者表现为白大衣高血压，25.8% 的患者表现为隐匿性高血压。只有 12.3% 的诊断和治疗患者呈现正常的血压值。70.63% 存在夜间（睡眠时间）高血压。睡眠时间收缩压平均值被发现是一个独立的血管危险因素 (F = 9.005, p< .001)，通过 10 年发病率和死亡率的风险间接衡量。此外，与清醒状态（ρ = 0.168，p < .01）或 24（ρ = 0.19，p < .01）相比，睡眠时间收缩压平均值升高是亚临床高血压介导的器官损伤（ρ = 0.19，p < .01）的更好标志0.184, p < .01) 收缩压平均值。总之，动态血压提供的准确性和睡眠时间测量使其与高血压诊断和管理特别相关。动态血压测量方法的使用最终可能会改变当前的治疗目标，睡眠时收缩压平均值成为主要目标，以优化高血压控制并降低高血压相关器官病理和心血管疾病的发病率和死亡率。