Parati G, Ulian L, Sampieri L, Palatini P, Villani A, Vanasia A, Mancia G
Clinica Medica, University of Milano-Bicocca and Ospedale S. Gerardo, Monza, Italy.
Hypertension. 2000 Feb;35(2):614-20. doi: 10.1161/01.hyp.35.2.614.
This study assessed whether 2 common surrogate measures of the "white-coat effect," namely the clinic-daytime and the clinic-home differences in blood pressure (BP), were attenuated by long-term antihypertensive treatment and whether this attenuation is relevant to the treatment-induced regression of left ventricular hypertrophy, thus having clinical significance. We considered data from 206 patients with essential hypertension (aged 20 to 65 years) who had a diastolic BP between 95 and 115 mm Hg and echocardiographic evidence of left ventricular hypertrophy. In each patient, clinic BP, 24-hour ambulatory BP, and left ventricular mass index were assessed at baseline, after 3 and 12 months of treatment with an angiotensin-converting enzyme inhibitor, and after a final 4-week placebo run-off period. At baseline, the clinic-daytime differences in systolic and diastolic BP were 12.1+/-15.4 and 6.8+/-10.1 mm Hg, respectively; the corresponding values for the clinic-home differences were 5.7+/-10.6 and 2.9+/-6.1 mm Hg, respectively. These differences were reduced by 57.6% and 77.1% (P<0.01) and by 65.7% and 64.3% (P<0.01), respectively, after 12 months of treatment, with a partial return toward the pretreatment differences after the final placebo period. The observed treatment-induced reductions in left ventricular mass index and those in the clinic-daytime or clinic-home differences for systolic and diastolic BP showed no significant relationship when tested by multiple regression analysis. This provides the first longitudinal evidence that clinic-daytime and clinic-home differences in BP have no substantial value in predicting the regression of target organ damage, such as left ventricular hypertrophy, that has prognostic relevance.
本研究评估了“白大衣效应”的两种常见替代指标，即诊室日间血压与诊室-家庭血压差值，是否会因长期降压治疗而减弱，以及这种减弱是否与治疗引起的左心室肥厚消退相关，从而具有临床意义。我们纳入了206例原发性高血压患者（年龄20至65岁）的数据，这些患者舒张压在95至115 mmHg之间，且有左心室肥厚的超声心动图证据。在每位患者中，在基线时、使用血管紧张素转换酶抑制剂治疗3个月和12个月后，以及在最后的4周安慰剂洗脱期后，评估诊室血压、24小时动态血压和左心室质量指数。基线时，收缩压和舒张压的诊室日间差值分别为12.1±15.4 mmHg和6.8±10.1 mmHg；诊室-家庭差值的相应值分别为5.7±10.6 mmHg和2.9±6.1 mmHg。治疗12个月后，这些差值分别降低了57.6%和77.1%（P<0.01），以及65.7%和64.3%（P<0.01），在最后的安慰剂期后部分恢复到治疗前的差值。通过多元回归分析测试时，观察到的治疗引起的左心室质量指数降低与收缩压和舒张压的诊室日间或诊室-家庭差值降低之间无显著关系。这提供了首个纵向证据，即血压的诊室日间和诊室-家庭差值在预测具有预后相关性的靶器官损害（如左心室肥厚）消退方面没有实质性价值。
