Risk factors and predictive model for masked hypertension in young and middle-aged adults

doi:10.3969/j.issn.1004-583X.2025.03.002

Abstract

Abstract:

Objective To investigate the risk factors of masked hypertension (MH) in young and middle-aged population and to develop a predictive model for MH diagnosis. Methods From January 2021 to December 2023, young and middle-aged adults who visited the cardiovascular outpatient clinic or underwent health check-up during the same period were recruited for questionnaire survey, physical examination, biochemical tests, waiting room blood pressure measurement and ambulatory blood pressure monitoring. The univariate and multifactorial logistic regression were performed to evaluate the risk factors of MH. Then a diagnostic prediction model was developed and a nomogram was created. The predictive performance of the model was evaluated using the receiver operator characteristic (ROC) curve. The bootstrap method (n=1000 times) was used for internally verification, and C-statistics, calibration curve and decision curve were created to evaluate the model. Results A total of 805 outpatients and health check-ups were included, with a prevalence rate of 18.9%(152/805). Compared to the normotensives, MH patients were elder, more male, and had significantly higher levels of body mass index (BMI), total cholesterol, triglycerides (TG), fasting blood glucose(FBG), and serum creatinine(SCR).Logistic regression revealed that age (OR=1.09, 95%CI: 1.07-1.11), BMI (OR=1.25, 95%CI: 1.15-1.35), log2(TG) (OR=1.29, 95%CI: 1.09-1.52), FBG(OR=1.28, 95%CI: 1.01-1.62) could be the independent risk factors for MH. Based on the above results, an MH prediction model and diagnostic nomogram were constructed for young and middle-aged adults, and the area under the ROC curve was 0.821. As for the internal verification by 1000 times bootstrap, the differentiation and calibration of the model were excellent. The decision curve showd that the model could yield a net benefit when the probability of MH was between 1% and 65%. Conclusion Age, BMI, FBG and TG are independent risk factors for MH in young and middle-aged adults. The prediction model based on the above risk factors has good differentiation, calibration and clinical benefit, which can contribute to the early and precisive identification of MH in outpatients.

Key words: masked hypertension, body mass index, triglycerides, fasting blood glucose, prediction model

CLC Number:

R544.1

Zhao Guangyan, Han Tuo, Liang Xiying, Wang Qian, Zhang Yan, Wang Congxia. Risk factors and predictive model for masked hypertension in young and middle-aged adults[J]. Clinical Focus, 2025, 40(3): 205-210.

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https://lchc.magtechjournal.com/EN/Y2025/V40/I3/205

Figures/Tables 5

References 20

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	总体(n=805)	正常血压组(n=653)	MH组(n=152)	Z/χ²值	P值
年龄(岁)	39.00[33.00, 48.00]	38.00[31.00, 46.00]	48.50[39.00, 55.25]	99.002	<0.001
男性[例(%)]	524(65.1)	405(64.0)	119(78.3)	14.361	<0.001
BMI(kg/m²)	24.50[22.00, 26.80]	24.00[21.50, 26.20]	26.30[24.20, 28.68]	68.478	<0.001
24 h收缩压(mmHg)	122.00[112.00, 131.00]	118.00[110.00, 126.00]	137.50[129.00, 147.00]	397.418	<0.001
24 h舒张压(mmHg)	78.00[70.00, 85.00]	76.00[68.00, 82.00]	92.00[85.00, 97.00]	405.117	<0.001
糖尿病[例(%)]	29(3.6)	13(2.0)	16(10.5)	25.867	<0.001
吸烟史[例(%)]
从不吸烟吸烟	617(76.6) 188(23.3)	518(79.3) 135(20.7)	99(65.1) 53(34.9)	13.879	0.001
血红蛋白(g/L)	152.00[137.00, 161.00]	151.00[136.00, 161.00]	154.50[144.00, 162.00]	9.497	0.005
总胆固醇(mmol/L)	4.37[3.88, 4.88]	4.33[3.85, 4.85]	4.54[4.09, 5.03]	5.476	0.005
TG(mmol/L)	1.34[0.93, 1.95]	1.25[0.88, 1.82]	1.81[1.29, 2.38]	32.935	<0.001
HDL-C(mmol/L)	1.20[1.00, 1.46]	1.22[1.01, 1.48]	1.10[0.95, 1.29]	14.612	<0.001
LDL-C(mmol/L)	2.67[2.23, 3.08]	2.64[2.20, 3.07]	2.80[2.31, 3.22]	1.293	0.099
FBG(mmol/L)	5.04[4.74, 5.38]	4.98[4.70, 5.30]	5.37[4.94, 5.93]	57.533	<0.001
血Cr(μmol/L)	74.20[64.20, 82.90]	73.30[63.60, 82.30]	78.75[67.98, 85.12]	9.099	0.001
脂肪肝[例(%)]	257(31.9)	181(27.7)	76(50.0)	28.167	<0.001
PSQI(分)	5.00[3.00, 8.00]	6.00[3.00, 8.00]	5.00[3.00, 8.00]	2.177	0.190

	总体(n=805)	正常血压组(n=653)	MH组(n=152)	Z/χ²值	P值
年龄(岁)	39.00[33.00, 48.00]	38.00[31.00, 46.00]	48.50[39.00, 55.25]	99.002	<0.001
男性[例(%)]	524(65.1)	405(64.0)	119(78.3)	14.361	<0.001
BMI(kg/m²)	24.50[22.00, 26.80]	24.00[21.50, 26.20]	26.30[24.20, 28.68]	68.478	<0.001
24 h收缩压(mmHg)	122.00[112.00, 131.00]	118.00[110.00, 126.00]	137.50[129.00, 147.00]	397.418	<0.001
24 h舒张压(mmHg)	78.00[70.00, 85.00]	76.00[68.00, 82.00]	92.00[85.00, 97.00]	405.117	<0.001
糖尿病[例(%)]	29(3.6)	13(2.0)	16(10.5)	25.867	<0.001
吸烟史[例(%)]
从不吸烟吸烟	617(76.6) 188(23.3)	518(79.3) 135(20.7)	99(65.1) 53(34.9)	13.879	0.001
血红蛋白(g/L)	152.00[137.00, 161.00]	151.00[136.00, 161.00]	154.50[144.00, 162.00]	9.497	0.005
总胆固醇(mmol/L)	4.37[3.88, 4.88]	4.33[3.85, 4.85]	4.54[4.09, 5.03]	5.476	0.005
TG(mmol/L)	1.34[0.93, 1.95]	1.25[0.88, 1.82]	1.81[1.29, 2.38]	32.935	<0.001
HDL-C(mmol/L)	1.20[1.00, 1.46]	1.22[1.01, 1.48]	1.10[0.95, 1.29]	14.612	<0.001
LDL-C(mmol/L)	2.67[2.23, 3.08]	2.64[2.20, 3.07]	2.80[2.31, 3.22]	1.293	0.099
FBG(mmol/L)	5.04[4.74, 5.38]	4.98[4.70, 5.30]	5.37[4.94, 5.93]	57.533	<0.001
血Cr(μmol/L)	74.20[64.20, 82.90]	73.30[63.60, 82.30]	78.75[67.98, 85.12]	9.099	0.001
脂肪肝[例(%)]	257(31.9)	181(27.7)	76(50.0)	28.167	<0.001
PSQI(分)	5.00[3.00, 8.00]	6.00[3.00, 8.00]	5.00[3.00, 8.00]	2.177	0.190

项目	单因素分析		多因素分析
项目	OR(95%CI)	P值	OR(95%CI)	P值
年龄	1.09 (1.07~1.11)	<0.001	1.09 (1.07~1.11)	<0.001
女性	0.45 (0.30~0.69)	<0.001
BMI	1.23 (1.17~1.30)	<0.001	1.23 (1.14~1.33)	<0.001
吸烟史	2.05 (1.40~3.01)	<0.001
血红蛋白	1.02 (1.01~1.03)	0.002
糖尿病	5.79 (2.72~12.32)	<0.001
总胆固醇	1.29 (1.04~1.59)	0.020
log2(TG)	2.11 (1.68~2.65)	<0.001	1.90 (1.31~2.75)	<0.001
HDL-C	0.31 (0.17~0.57)	<0.001
FBG	1.84 (1.50~2.25)	<0.001	1.27 (1.00~1.61)	0.048
血Cr	1.02 (1.01~1.03)	0.003
脂肪肝	2.61 (1.82~3.74)	<0.001
PSQI	0.96 (0.92~1.01)	0.141

项目	单因素分析		多因素分析
项目	OR(95%CI)	P值	OR(95%CI)	P值
年龄	1.09 (1.07~1.11)	<0.001	1.09 (1.07~1.11)	<0.001
女性	0.45 (0.30~0.69)	<0.001
BMI	1.23 (1.17~1.30)	<0.001	1.23 (1.14~1.33)	<0.001
吸烟史	2.05 (1.40~3.01)	<0.001
血红蛋白	1.02 (1.01~1.03)	0.002
糖尿病	5.79 (2.72~12.32)	<0.001
总胆固醇	1.29 (1.04~1.59)	0.020
log2(TG)	2.11 (1.68~2.65)	<0.001	1.90 (1.31~2.75)	<0.001
HDL-C	0.31 (0.17~0.57)	<0.001
FBG	1.84 (1.50~2.25)	<0.001	1.27 (1.00~1.61)	0.048
血Cr	1.02 (1.01~1.03)	0.003
脂肪肝	2.61 (1.82~3.74)	<0.001
PSQI	0.96 (0.92~1.01)	0.141