Abstract
Objective: The problem of masked hypertension (MH) in medicated patients is very important due to their high cardiovascular risk. The aim of our study was to determine the prevalence of MH in various patients’ groups. Design and Method: Two groups of patients with the stable hypertension grade 1-2 were compared. Group I included 219 patients with the single measurement of clinical (CBP) and 24h ambulatory blood pressure (ABP) after 4-8 weeks of monotherapy by 9 antihypertensive drugs. Group II included 39 patients from cross-over randomized trial of amlodipine and spirapril. These participants underwent at least 7 visits to the clinic for CBP control. ABP monitoring was performed at the end of each treatment course (4 weeks). The additional diagnostic methods were: ECG (in group II), General Well-Being Questionnaire (GWBQ). MH was determined as CBP<140/90 mm Hg and daytime ABP>=135/85 mm Hg. To summarize the data the analysis of 2x2 contingency tables was done. The multivariate logistic procedure in stepwise mode and Spearman correlation analysis were used for assessment of MH predictors in groups I and II respectively. The analysis models were sex and age adjusted. Results: The prevalence of MH in group I was 11.5%, in group II - 37.5-41.9%. We found initial differences between groups: age (57.7 ± 0.6 and 53.7 ± 1.6 years, p < 0.05), body mass index (BMI; 29.0 ± 0.3 and 30.3 ± 0.8, p < 0.05), GWBQ scale III (7.7 ± 0.3 and 9.1 ± 0.5, p < 0.01) and VI (7.9 ± 0.3 and 9.0 ± 0.5, p < 0.05). MH in group I was associated with: GWBQ scales II, V, VI; intake of metoprolol and amlodipine (positive correlation [+]). MH in group II correlated with: increased orthostatic BP, ECG criteria of left ventricular hypertrophy, GWBQ scales I, IV, VI (+); age, BMI, previous antihypertensive medication, alcohol intake (negative correlation). Conclusions: The prevalence of MH in medicated hypertensive patients may depend on initial patients’ characteristics, prescribed drugs and the factor of repeated visits to the clinic (due to CBP regression to the mean).
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