Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Porcellati C
Unità Operativa di Cardiologia, Ospedale Regionale Raffaello Silvestrini, Perugia, Italy.
Blood Press Monit. 1998 Jun;3(3):147-152.
The coexistence of persistently high office blood pressure with normal blood pressujre outside the medical setting is often referred to as 'white-coat', 'office' or 'isolated clinic' hypertension. The definition of normal blood pressure outside the medical setting is controversial. In our experience, not only the prevalence of white-coat hypertension, but also left ventricular mass measured echocardiographically and the prevalence of left ventricular hypertrophy in this condition markedly vary on going from more restrictive (lower) to more liberal (higher) limits of ambulatory blood pressure normalcy over quite a narrow range. In a prospective study, cardiovascular morbidities of healthy normotensive controls and subjects with white-coat hypertension did not differ. A more recent analysis of our database supports the use of qujite a restrictive definition of white-coat hypertension (average daytime blood pressure < 130/80 mmHg) in order to identify the minority of subjects who have a low risk of cardiovascular morbid events during the subsequent years. A recent document published by the American Society of Hypertension suggests that slightly higher upper limits of ambulatory blood pressure normalcy (i.e. average daytime blood pressure < 135 mmHg systolic and 85 mmHg diastolic) should be used. In a follow-up study by our group, 37% of subjects with white-coat hypertension spontaneously evolved into cases of ambulatory hypertension, with accompanying increases in left ventricular mass. In that study, the probability of a subject developing ambulatory hypertension increased with the baseline values of ambulatory blood pressure and it was quite low (20%) for those with daytime blood pressures below 130/80 mmHg. In two recent controlled studies, the rate of development of ambulatory hypertension over time for untreated subjects did not differ between the normotensive control group and the group with white-coat hypertension. A final answer regarding the clinical significance of white-coat hypertension will come from very large surveys of the natural history of this condition in the long term. For now, we suggest a verdict of innocence for white-coat hypertension when low values of daytime ambulatory blood pressure (i.e. < 130/80 mmHg) and absence of organ lesions and other risk factors coexist.
诊室血压持续居高不下而在医疗环境之外血压正常的情况，常被称为“白大褂”、“诊室”或“孤立诊所”高血压。医疗环境之外正常血压的定义存在争议。根据我们的经验，不仅白大褂高血压的患病率，而且通过超声心动图测量的左心室质量以及在此情况下左心室肥厚的患病率，在从动态血压正常范围的更严格（更低）到更宽松（更高）界限的相当窄范围内都会显著变化。在一项前瞻性研究中，健康血压正常的对照组和白大褂高血压患者的心血管疾病发病率并无差异。我们数据库的一项最新分析支持采用相当严格的白大褂高血压定义（白天平均血压<130/80 mmHg），以便识别出在随后几年中心血管疾病发病风险较低的少数人群。美国高血压学会最近发布的一份文件建议应采用稍高的动态血压正常上限（即白天平均收缩压<135 mmHg，舒张压<85 mmHg）。在我们团队的一项随访研究中，37%的白大褂高血压患者自发演变为动态高血压病例，同时左心室质量增加。在该研究中，受试者发展为动态高血压的概率随动态血压的基线值增加，而对于白天血压低于130/80 mmHg的患者，这一概率相当低（20%）。在最近的两项对照研究中，未经治疗的受试者随着时间推移发展为动态高血压的发生率在血压正常对照组和白大褂高血压组之间并无差异。关于白大褂高血压临床意义的最终答案将来自对这种情况长期自然史的大规模调查。目前，当白天动态血压值较低（即<130/80 mmHg）且不存在器官病变和其他危险因素时，我们建议对白大褂高血压作出无危害的判定。
