Saito I, Murata K, Tsujioka M, Kawabe H, Saruta T
Health Centre, Department of Medicine, Keio University, Tokyo, Japan.
Blood Press Monit. 1998 Apr;3(2):97-100.
White-coat hypertension, defined as hypertensive blood pressure values in a clinical setting but normal self-measured blood pressures, is relatively common among young patients but long-term spontaneous changes in clinic blood pressure in these patients with white-coat hypertension have not been assessed. DESIGN: A prospective study, with two clinical examinations (with a 5-year interval between the examinations).METHODS: We examined 188 male patients (mean age 16 years) with clinic blood pressures > 140/90 mmHg at baseline by determining clinic and home blood pressures, heart rates, heights and weights. These parameters were re-examined 5 years later. White-coat hypertension (n = 139) was defined as an average home blood pressure < 130/90 mmHg.RESULTS: A decrease in clinic systolic blood pressure to < 140 mmHg during the 5-yea follow-up was observed in 101 of the 139 patients with white-coat hypertension (73%) and 26 of the 49 patients with sustained hypertension (53%, P < 0.02). There was no difference between clinic heart rates and body mass indices at baseline of the patients who remained hypertensive in the clinic and those who became normotensive. Both the white-coat and the sustained hypertensive patients who remained hypertensive had higher baseline home blood pressures and an increase in body mass index during the 5-year period and maintained the baseline clinic heart rate, whereas those who became normotensive exhibited a reduction in clinic heart rate and maintained the baseline body mass indexd. The clinic systolic blood pressure at 5-year follow-up was correlated significantly to the clinic and home systolic blood pressures at baseline, the heart rate and body mass indexd at 5-year follow-up and the changes in bodyh mass index during the 5-year period. CONCLUSION: The prevalence of clinic systolic blood pressures < 140 mmHg during the 5-year period among patients with white-coat hypertension was higher than that among those with sustained hypertension. The clinic and home blood pressures at baseline and body mass indices and clinic heart rates at 5-year follow-up were related to the clinic systolic blood pressures at 5-year follow-up. These results suggest that control of body weight is important in the management both of young patients with white-coat hypertension and of those with sustained hypertension.
白大衣高血压定义为临床环境中血压值升高但自测血压正常，在年轻患者中相对常见，但这些白大衣高血压患者临床血压的长期自然变化尚未得到评估。
一项前瞻性研究，进行两次临床检查（两次检查间隔5年）。
我们通过测定临床和家庭血压、心率、身高和体重，检查了188例男性患者（平均年龄16岁），他们在基线时临床血压>140/90 mmHg。5年后对这些参数进行重新检查。白大衣高血压（n = 139）定义为平均家庭血压<130/90 mmHg。
在139例白大衣高血压患者中，有101例（73%）在5年随访期间临床收缩压降至<140 mmHg，49例持续性高血压患者中有26例（53%）出现这种情况（P < 0.02）。临床仍为高血压的患者与血压恢复正常的患者在基线时的临床心率和体重指数无差异。临床仍为高血压的白大衣高血压患者和持续性高血压患者在5年期间基线家庭血压较高，体重指数增加，并维持基线临床心率，而血压恢复正常的患者临床心率降低，并维持基线体重指数。5年随访时的临床收缩压与基线时的临床和家庭收缩压、5年随访时的心率和体重指数以及5年期间体重指数的变化显著相关。
白大衣高血压患者在5年期间临床收缩压<140 mmHg的患病率高于持续性高血压患者。基线时的临床和家庭血压以及5年随访时的体重指数和临床心率与5年随访时的临床收缩压有关。这些结果表明，控制体重对于年轻白大衣高血压患者和持续性高血压患者的管理都很重要。
