Cases analysis of rational use of medicine (50)Masked Hypertension

1.Patient'sconditions

Patient,male,age of 65,had headache and dizziness for some times.Bp measured at home was always 137～142/85～92 mmHg.But,Bp measured at hospitals was always <140/90 mmHg.

Ambulatory blood pressures (ABP):≥140/90 mmHg Patient was suspected to have MH.

2.Drugadministration

Amlodipine besylate Tab. 5 mg qd

3.Analysis

Masked hypertension(MH) is a special type of hypertension.Target organ damage and high risk of cardiovascular are closely associated with MH as well as sustained hypertension(SH).

(1)MH diagnosis

When office blood pressures (OBP) of patient are normal,but home blood pressures (HBP) or ambulatory blood pressures (ABP) are higher than normal,which can be considered as MH.OBP is <140/90 mmHg,but it is often nearly to upperlimit of normotension.Hypertension has already occured on the patients,the actual state of patients is only hidden from the doctors.

In accordance with explanation by ESC/ESH,for the adult,MH means that OBP <140/90 mmHg,but in the measure of HBP,SBP≥135 mmHg,and/or DBP≥85 mmHg;And/or OBP<140/90 mmHg,in the measure of ABP,daytime SBP≥135 mmHg,and/or day time DBP≥85 mmHg.

Some cardiovascular disease experts in China say that In the measure of HBP，SBP≥135 mmHg,DBP≥85 mmHg；in the measure of ABP,daytime SBP≥135 mmHg,daytime DBP≥85 mmHg,nocturnal SBP≥125 mmHg,nocturnal DBP≥75 mmHg,but OBP<140/90 mmHg,which can be diagnosed as MH.

(2)MH and Target organ damage,cardiovascular events.

Recently,reports of large prospective studies aimed at MH have shown that the patients with MH have the same target organ damage and cardiovascular event probabilities as the patients with SH,compared with control group with normotension,they are found to be characterized by larger LVMI,relative thickened ventricular wall,high arterial stiffness,high possibility of developing of SH,and high probability of target organ damage and cardiovascular events.

(3)High risk group of MH

according to viewpoint of ESH,MH is very likely to develop in juvenile with upperlimit of normotension (OBP) and earlier LVH,patients with hypertensive parents,patients with multiple risk factors of cardiovascular diseases and diabetes,and so on.

(4)Treatment of MH

The probabilities of target organ damage and cardiovascular events caused by MH are much higher than by normotension and WCH,pharmacological therapy is necessary.

main approaches to treatment of MH

①Life-style modifications for reduction of cardiovascular risk factors e.g. stopping smoking,reducing stress,moderating alcohol consumption,and decreasing salt intake etc.

②pharmacological intervention

If MH diagnosis is confirmed,risk stratification of patient's cardiovascular disease should be identified and the therapy should be given as treating pattern of SH.Intensified therapy of antihypertensive agents should be administered to patients with high or very high risk.

Early morning hypertension is controlled by night administration of antihypertensives,such as α-receptor blockers,daytime hypertension by morning use of β-receptor blockers,nocturnal hypertension by diuretics.ACEI,ARB,long-acting CCB,highly-selective β-receptor blocker,which have advantage of target organ protection based on medicine-evidence,should be used.

(4)Therapeutic effect evaluation is based on regular or irregular check on HBP or ABP rather than OBP,and then medicating regimen can be modified.