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Characteristics of Patients with Reproducible Masked Hypertension and its Diagnosis Approach

https://doi.org/10.20996/1819-6446-2019-15-6-789-794

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Abstract

Background. Early diagnostics of masked hypertension (MH) is one of the key problems in modern cardiology due to the association of this blood pressure (BP) phenotype with doubled cardiovascular risk in comparison with normotension (NT). The current hypertension guidelines list numerous conditions, when the ambulatory BP monitoring (ABPM) is desirable in patients with normal office BP. However this list does not represent clearly defined, agreed and approved indications for ABPM as a diagnostic tool for MH.

Aim. To develop a method of MH diagnostics for the use in routine clinical practice based on the comparing characteristics of patients with reproducible MH vs NT.

Material and methods. The patients were selected from two trials that used ABPM (n=1778). The selection criteria included age 40-79 years, office BP<140/90 mm Hg, the absence of “hypertension” diagnosis or antihypertensive drug intake, and available results of two examinations (winter and summer): standard questionnaire, information about family history, chronic diseases and drug intake, height, weight, office and orthostatic BP and ABPM. We used the following definition of MH: elevated ambulatory BP (24-hour ≥130 and/or 80 mm Hg, daytime ≥135 and/or 85 mm Hg, or nighttime ≥120 and 70 mmHg) registered at both visits.

Results. In total, 153 patients with reproducible (both winter and summer) BP phenotype were included: 127 with MH, and 26 with NT (mean age 49.1Ѓ}7.8 years, 36.1% males). In multivariate analysis, reproducible MH was associated with body mass index (β2.097; p<0.0001), office diastolic BP (β2.152; p<0.0001), orthostatic systolic BP (β1.031; p<0.023) and orthostatic heart rate (β0.773; p=0.19). These parameters were used in the original “MH coefficient” formula.

Conclusions. MH is often found in patients with normal and optimal office BP and without “hypertension” diagnosis. The method described in the article helps to detect MH with high probability and define the individual indications for ABPM. The MH phenomenon in the category of patients warrants further investigation.

About the Authors

М. I. Smirnova
National Medical Research Center for Preventive Medicine
Russian Federation

Marina I. Smirnova – MD, PhD, Head of Laboratory for Prevention of Chronic Respiratory diseases

Petroverigsky per. 10, Moscow, 101990



V. M. Gorbunov
National Medical Research Center for Preventive Medicine
Russian Federation

Vladimir M. Gorbunov – MD, PhD, Professor, Head of Ambulatory Diagnostic Methods Laboratory

Petroverigsky per. 10, Moscow, 101990



Ya. N. Koshelyaevskaya
National Medical Research Center for Preventive Medicine
Russian Federation

Yana N. Koshelyaevskaya – Programmer, Ambulatory Diagnostic Methods Laboratory

Petroverigsky per. 10, Moscow, 101990



A. D. Deev
National Medical Research Center for Preventive Medicine
Russian Federation

Alexander D. Deev – PhD, Leading Researcher, Department of Epidemiology of Chronic Noncommunicable Diseases

Petroverigsky per. 10, Moscow, 101990



D. A. Volkov
National Medical Research Center for Preventive Medicine
Russian Federation

Dmitriy A. Volkov – MD, PhD, Cardiologist, National Medical Research Center for Preventive Medicine

Petroverigsky per. 10, Moscow, 101990



N. V. Furman
Regional Clinical Cardiology Dispensary; Saratov State Medical University named after V. I. Razumovsky
Russian Federation

Nikolay V. Furman – MD, PhD, Cardiologist, Saratov Regional Clinical Cardiological Dispensary; Assistant, Chair of Faculty Therapy, Saratov State Medical University named after V. I. Razumovsky

53 Strelkovoj divizii ul. 8, Saratov, 410028 

Bolshaya Kazachya ul. 112, Saratov, 410012



P. V. Dolotovskaya
Saratov State Medical University named after V. I. Razumovsky
Russian Federation

Polina V Dolotovskaya – PhD, Senior Lecturer, Chair of Pharmacology

Bolshaya Kazachya ul. 112, Saratov, 410012



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For citation:


Smirnova М.I., Gorbunov V.M., Koshelyaevskaya Y.N., Deev A.D., Volkov D.A., Furman N.V., Dolotovskaya P.V. Characteristics of Patients with Reproducible Masked Hypertension and its Diagnosis Approach. Rational Pharmacotherapy in Cardiology. 2019;15(6):789-794. (In Russ.) https://doi.org/10.20996/1819-6446-2019-15-6-789-794

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ISSN 1819-6446 (Print)
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