Yan Li, M.D., Ph.D
Professor of Cardiovascular Medicine,
Shanghai Institute of Hypertension,
Shanghai Jiaotong University School of Medicine, Shanghai, China
Yan Li is currently a professor of cardiovascular medicine and vice director of the Center for Vascular Evaluations and Center for Community Studies at the Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine. She is a member of Women in Hypertension Research Committee (WiHR) of the International Society of Hypertension (ISH) and vice secretary in general of Chinese Hypertension League (CHL).
Her research interests are on population and clinical studies on hypertension and arterial stiffness. She has published more than 260 articles in the international literature and currently serves as associate editor for Blood Pressure and the Journal of Clinical Hypertension and editorial board member for Hypertension, Hypertension Research and Chinese Hypertension Journal.
Masked hypertension and pulse wave velocity
Department of Cardiovascular Medicine, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, State Key Laboratory of Medical Genomics, National Research Centre for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
Objective: Masked hypertension is associated with target organ damage, such as arterial stiffness. Current guidelines recommend early initiation of antihypertensive treatment to patients with masked hypertension. However, there is no direct evidence that the hypertensive treatment will be beneficial.
Design and Method: From Feb 2017 to Oct 2021, we conducted the ANTIhypertensive treatment in MASKed hypertension for target organ protection (ANTI-MASK) trial in China. It is a multicenter, randomized, double-blind, placebo-controlled trial (NCT02893358). Patients who were 30 to 70 years old, and had untreated masked hypertension and at least one sign of target organ damage (TOD) were randomized to either the treatment of placebo or alisartan 80-160 mg with necessary add-on of amlodipine 2.5 mg. TOD included electrocardiogram diagnosed left ventricular hypertrophy (LVH), brachial-ankle pulse wave velocity (ba-PWV) ≥1400 cm/s, or a random urinary albumin-to-creatinine ratio (ACR) ≥2.5 mg/mmol in men and ≥3.5 mg/mmol in women. The primary endpoint was the improvement rate of TOD after 12 months treatment, defined as the reverse (yes to no) of TOD or a significant decrease of ba-PWV or ACR by ≥20% of the baseline level.
Results: Totally 317 patients (43.2% women, mean age 54 years) were randomized in 13 hospitals in China. The TOD improvement rate, and the decrease of ba-PWV (-142.3 cm/s vs 24.9 cm/s, P<0.001) were significantly greater in the treatment group as compared to the placebo group, as well as the decrease of the 24-h systolic/diastolic BPs (-9.1/-5.7 vs -1.5/-1.0 mmHg, P<0.001).
Conclusions: Antihypertensive treatment was beneficial for patients with masked hypertension in terms of TOD protection, mainly in the improvement of arterial stiffness.
Keywords: masked hypertension, target organ damage, pulse wave velocity, trial