Clinical Research On Masked Hypertension

Objective:Masked hypertension(MHT)is a special type of hypertension,which refers to a normal office blood pressure in the presence of an elevated out-of-office blood pressure.Up to now,we know little about effective methods of the screening,diagnosis and treatement of MHT.The purpose of this study is to investigate target organ damage in relation to different subtypes of MHT,the clinical feasures and potential biomarkers,and treatment of MHT in Chinese.Methods:Firstly,we investigated the relationship between subtypes of MHT and target organ damage including arteriosclerosis,cardiac function and renal function in untreated patients recruited from the hypertension clinic of Ruijin hospital.Secondly,we used the database of China Nationwide Ambulatory and Home Blood Pressure Registry(ABPR)to analyse the risk factors of MHT,especially the influence of current cigarette smoking.Then,we used liquid chromatography tandem mass spectrometry method to screen and validate the possible biomarkers and metabolic pathways of isolated nocturnal hypertension(INH).Finally,we designed and completed a randomized controlled trial entitled as "The Short-term Efficacy and Safety of Gastrodia-Uncaria Granules in Treating Masked Hypertension" to clarify the antihypertensive efficacy and safety of gastrodia-uncaria granules(GUG)in the treatment of MHT.Results:Among the 1808 untreated patients recruited from the hypertension clinic of Ruijin hospital,MHT accounted for 37%.After multivariate adjustment,patients with isolated daytime MHT had higher carotid-femoral pulse wave velocity and carotid intima-media thickness(CIMT)than normotensive subjects.While patients with isolated nighttime MHT had higher urinary albumin-to-creatinine ratio and CIMT than normotensive subjects.Patients with day-night MHT were correlated with the increase of the target organ damage indexes mentioned above.Ambulatory daytime and nighttime BPs were significantly and similarly(P≥0.20)associated with target organ measurements.1646 male patients from 54 hospitals nationwide were registered in ABPR and finally included in the present analysis.Multiple logistic regression showed current cigarette smoking was significantly associated with MHT defined by daytime ambulatory and evening home BP,with an odds ratio(95%confidence interval)of 1.69(1.27-2.25)and 1.81(1.33-2.47),respectively,but not associated with MHT defined by nighttime ambulatory and morning home BP.The results of metabolomics of INH showed that sphingomyelins metabolic pathway and ceramides(the core metabolite of sphingomyelins metabolic pathway)were related to the occurrence of INH.The clinical trial showed that GUG can significantly reduce the daytime and 24-h ambulatory BP with a between-group difference of 3/2 mmHg(P≤0.025/0.011)compared to placebo after four weeks of treatment in patients with MHT.The results of per-protocol analysis were concordant with the intention-to-treat analysis.Conclusions:MHT is closely related to target organ damage irrespective of the subtypes.Daytime and nighttime BPs were equally and independently associated with target organ measures.Smoking is associated with daytime MHT,and sphingomyelins metabolic pathway associated with INH.GUG,as a classic traditional Chinese medicine,can effectively reduce ambulatory BP in patients with MHT,deserving further research.