Prevalence of Masked and White-Coat Hypertension in Pre-Hypertensive and Stage 1 Hypertensive patients with the use of TeleMRPA

Abstract Background: The diagnosis of arterial hypertension based on measurements of blood pressure in the office has low accuracy. Objective: To evaluate the prevalence of masked hypertension (MH) and white-coat hypertension through home blood pressure monitoring (HBPM) in pre-hypertensive and stage 1 hypertensive patients. Method: Retrospective study, of which sample consisted of individuals with BP ≥ 120/80 mmHg and < 160/100 mmHg at the medical office without the use of antihypertensive medication and who underwent exams on the HBPM platform by telemedicine (TeleMRPA) between May 2017 and September 2018. The four-day MRPA protocol was used, with 24 measurements, using automated, validated, calibrated equipment with a memory function. Results: The sample consisted of 1,273 participants, of which 739 (58.1%) were women. The mean age was 52.4 ± 14.9 years, mean body mass index (BMI) 28.4 ± 5.1 kg/m2. The casual BP was higher than the HBPM in 7.6 mmHg for systolic blood pressure (SBP) and 5.2 mmHg for diastolic blood pressure (DBP), both with statistical significance (p < 0.001). There were 558 (43.8%) normotensive individuals; 291 (22.9%) with sustained hypertension; 145 (11.4%) with MH and 279 (21.9%) with white-coat hypertension (WCH), with a diagnostic error by casual BP in the total sample in 424 (33.3%) patients. In stage 1 hypertensive individuals, the prevalence of WCH was 48.9%; in prehypertensive patients, the prevalence of MH was 20.6%. Conclusion: MH and WCH have a high prevalence rate in the adult population; however, in prehypertensive or stage 1 hypertensive patients, the prevalence is higher. Out-of-office BP measurements in these subgroups should be performed whenever possible to prevent misdiagnosis.

【背景】基于诊室血压测量的动脉高血压诊断准确性较低。【目的】通过家庭血压监测（home blood pressure monitoring, HBPM）评估高血压前期与1级高血压患者的隐性高血压（masked hypertension, MH）及白大衣高血压（white-coat hypertension, WCH）患病率。【方法】本研究为回顾性研究，纳入2017年5月至2018年9月期间，于远程医疗平台TeleMRPA的家庭血压监测系统中完成检测、未使用降压药物且诊室血压≥120/80 mmHg且＜160/100 mmHg的受试者作为研究样本。采用为期4天的MRPA监测方案，共获取24组血压数据，监测设备为经校准、验证且具备存储功能的自动化血压测量仪器。【结果】本研究共纳入1273名受试者，其中女性739名（占比58.1%）；平均年龄为52.4±14.9岁，平均体质量指数（body mass index, BMI）为28.4±5.1 kg/m²。诊室偶测收缩压（systolic blood pressure, SBP）较家庭血压监测值高7.6 mmHg，诊室偶测舒张压（diastolic blood pressure, DBP）较家庭血压监测值高5.2 mmHg，差异均具有统计学意义（p＜0.001）。受试者中，血压正常者558名（43.8%），持续性高血压者291名（22.9%），隐性高血压者145名（11.4%），白大衣高血压者279名（21.9%）；整体样本中，诊室血压诊断存在误差的受试者共424名（33.3%）。在1级高血压受试者中，白大衣高血压患病率为48.9%；在高血压前期患者中，隐性高血压患病率为20.6%。【结论】成人人群中隐性高血压与白大衣高血压患病率较高，而在高血压前期或1级高血压亚组中，二者患病率更高。对于此类亚组人群，应尽可能实施诊室外血压测量，以避免误诊。