Assessment of cardiometabolic risk factors in various phenotypes of masked hypertension

Aim. To assess the relationship of cardiometabolic risk factors in patients with various phenotypes of masked hypertension (MH).

Material and methods. The study included 207 men with a median age of 34,6 years [32,3; 36,3] being systematically stressed. All examined patients had normal clinical blood pressure (BP), and there was no history of its increase. We conducted 24-hour ambulatory blood pressure monitoring (ABPM), carotid duplex scan with determination of the intima- media thickness (IMT). The levels of total cholesterol (TC), low (LDLC) and high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) were determined. Body mass index, visceral adiposity index, lipid accumulation product index and waist-to-height ratio were calculated. We performed clustering of ABPM data, calculated the odds ratio of association between cardiometabolic risk factors and certain MH phenotypes.

Results. MH was diagnosed in 142 (68,6%) patients examined, divided into 3 clusters: systolic-diastolic — SDMH (50,7%), isolated systolic — ISMH (27,5%) and isolated diastolic — IDMH (21,8%). Impaired lipid metabolism, visceral adiposity, IMT increase and atherosclerotic plaques were more often recorded in patients with SDMH and IDMH. The levels of TC, LDL-C and IMT were highest in individuals with IDMH. Odds ratio analysis indicated significant associations of SDMH and IDMH phenotypes with indicators of visceral adiposity, IMT, TG, TC, LDL-C and TG/HDL-Cl.

Conclusion. Clustering of ABPM data in individuals with MH and comparing related phenotypes with cardiometabolic risk factors complements their clinical and functional characteristics and can be a useful tool for improving customized prevention and therapy programs.

1. Chazova IE. Arterial hypertension in the light of current recommendations. Terapevt arkh. 2018;90(9):4-7. (In Russ.) doi:10.26442/terarkh20189094-7.

2. Erina AM, Rotar OP, Solntsev VN, et al. Epidemiology of Arterial Hypertension in Russian Federation — Importance of Choice of Criteria of Diagnosis. Kardiologiia. 2019;59(6):5-11. (In Russ.) doi:10.18087/cardio.2019.6.2595.

3. Geltser BI, Kotelnikov VN, Vetrova OO, Karpov RS. Masked arterial hypertension: prevalence, pathophysiological determinants and clinical significance. Russ J Cardiol. 2019;24(9):92-8. (In Russ.) doi:10.15829/1560-4071-2019-9-92-98.

4. Lyamina NP, Nalivaeva AV, Senchikhin VN, Lipchanskaya TP. Masked hypertension in young persons: prevalence, significance of cardiovascular risk factors and prognosis by gender differences. Russ J Cardiol. 2017;22(4):7-12. (In Russ.) doi:10.15829/1560-4071-2017-4-7-12.

5. Booth JN 3rd, Muntner P, Diaz KM, et al. Evaluation of criteria to detect masked hypertension. J Clin Hypertens. 2016;18(11):1086-94. doi:10.1111/jch.12830

6. Cuspidi C, Sala C, Tadic M, et al. Untreated masked hypertension and subclinical cardiac damage: a systematic review and metaanalysis. Am J Hypertens. 2015;28(6):806-13. doi:10.1093/ajh/hpu231.

7. Shalnova SA, Deev AD, Muromtseva GA, et al Relation of anthropometric indexes and coronary heart disease. Cardiovascular Therapy and Prevention. 2018;17(3):11-6. (In Russ.) doi:10.15829/1728-8800-2018-3-11-16.

8. Colantonio LD, Anstey DE, Carson AP, et al. Metabolic syndrome and masked hypertension among African Americans: The Jackson Heart Study. J Clin Hypertens. 2017;19(6):592-600. doi:10.1111/jch.12974.

9. Asayama K, Thijs L, Li Y, et al. International database on ambulatory blood pressure in relation to cardiovascular outcomes (IDACO) investigators. Setting thresholds to varying blood pressure monitoring intervals differentially affects risk estimates associated with white-coat and masked hypertension in the population. Hypertension. 2014;64(5):935-42. doi:10.1161/HYPERTENSIONAHA.114.03614.

10. Hänninen MR, Niiranen TJ, Puukka PJ, et al. Target organ damage and masked hypertension in the general population: the Finn-Home study. J Hypertens. 2013;31(6):1136-43. doi:10.1097/HJH.0b013e32835fa5dc.

11. Palla M, Saber H, Konda S, Briasoulis A. Masked hypertension and cardiovascular outcomes: an updated systematic review and meta-analysis. Integr Blood Press Control. 2018;11:11-24. doi:10.2147/IBPC.S128947.