Hypertension：合并隐匿性高血压的糖尿病患者需进一步降压治疗

尽管大家对糖尿病患者隐匿性高血压（masked hypertension）的特点已经很清楚。然而对于这些患者临床上进行降压治疗的意义尚未完全清楚。IDACO研究（The current International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes ）中的受试者来自11个国家，采用常规血压（CBP）和动态血压（ABP）监测，在中位期为11年的随访中观察心血管事件。受试者中有众多糖尿病患者，这些患者中许多合并有隐匿性高血压，其中部分接受降压治疗。来自比利时的研究人员通过对此数据分析发现糖尿病患者有隐匿性高血压如未接受治疗，其心血管风险等于高血压1级患者，他们需更大幅度的降低CBP以达到ABP治疗目标。
研究人员通过分析9691例受试者发现，糖尿病患者中未治疗的隐匿性高血压发生率（229；29.3%，n=67）高于非糖尿病患者（5486；18.8%，n=1031）。在中位时间为11年的随访中，未接受治疗的糖尿病隐匿性高血压患者复合心血管终点的危险（校正后）有高于正常血压受试者的趋势（HR=1.96，95%CI，0.97–3.97; P=0.059）但低于高血压2级患者（HR=0.53; CI, 0.29–0.99; P=0.048）；未治疗的高血压1级患者也有类似增高风险趋势（HR=1.07；CI，0.58–1.98；P=0.82）。
与此相对应的是，在接受降压治疗的糖尿病隐匿性高血压患者的心血管危险与正常血压组（（HR, 1.13; CI, 0.54–2.35; P=0.75）、高血压1级（HR, 0.91; CI, 0.49–1.69; P=0.76）和高血压2级（HR, 0.65; CI, 0.35–1.20; P=0.17）相比并无明显差异。
未治疗的糖尿隐匿性高血压患者的平均收缩/舒张压为129.2±8.0/76.0±7.3 mm Hg，平均日间收缩/舒张压为141.5±9.1/83.7±6.5 mm Hg。
研究人员最后总结指出，在糖尿病患者中未治疗隐匿性高血压患者约占29%，其心血管风险与高血压1级患者相似，因此需进一步降低常规血压（CBP）以达到日间动态血压（ABP）治疗目标。需要特别指出的是，许多合并高血压的糖尿患者在接受降压治疗后表现为正常CBP及升高的ABP，这一特点与隐匿性高血压相似。

Masked hypertension in diabetes mellitus: treatment implications for clinical practice.
Abstract
Although distinguishing features of masked hypertension in diabetics are well known, the significance of antihypertensive treatment on clinical practice decisions has not been fully explored. We analyzed 9691 subjects from the population-based 11-country International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes. Prevalence of masked hypertension in untreated normotensive participants was higher (P<0.0001) among 229 diabetics (29.3%, n=67) than among 5486 nondiabetics (18.8%, n=1031). Over a median of 11.0 years of follow-up, the adjusted risk for a composite cardiovascular end point in untreated diabetic-masked hypertensives tended to be higher than in normotensives (hazard rate [HR], 1.96; 95% confidence interval [CI], 0.97-3.97; P=0.059), similar to untreated stage 1 hypertensives (HR, 1.07; CI, 0.58-1.98; P=0.82), but less than stage 2 hypertensives (HR, 0.53; CI, 0.29-0.99; P=0.048). In contrast, cardiovascular risk was not significantly different in antihypertensive-treated diabetic-masked hypertensives, as compared with the normotensive comparator group (HR, 1.13; CI, 0.54-2.35; P=0.75), stage 1 hypertensives (HR, 0.91; CI, 0.49-1.69; P=0.76), and stage 2 hypertensives (HR, 0.65; CI, 0.35-1.20; P=0.17). In the untreated diabetic-masked hypertensive population, mean conventional systolic/diastolic blood pressure was 129.2±8.0/76.0±7.3 mm Hg, and mean daytime systolic/diastolic blood pressure 141.5±9.1/83.7±6.5 mm Hg. In conclusion, masked hypertension occurred in 29% of untreated diabetics, had comparable cardiovascular risk as stage 1 hypertension, and would require considerable reduction in conventional blood pressure to reach daytime ambulatory treatment goal. Importantly, many hypertensive diabetics when receiving antihypertensive therapy can present with normalized conventional and elevated ambulatory blood pressure that mimics masked hypertension.