Vaindirlis I, Peppa-Patrikiou M, Dracopoulou M, Manoli I, Voutetakis A, Dacou-Voutetakis C
Endocrine Unit and Diabetes Center, First Pediatric Department, Athens University, "Aghia Sophia" Children's Hospital, Athens, Greece.
J Pediatr. 2000 Mar;136(3):359-64. doi: 10.1067/mpd.2000.103410.
To investigate whether "white coat hypertension" (WCH) in adolescents is an innocent phenomenon or is associated with early changes of the vascular system and/or increased stress response, reflected in the urinary endothelin and cortisol values, respectively.
The study group included 36 subjects, 14 with WCH (8 males and 6 females) aged 12.9 +/- 3 years and 22 normotensive control subjects (12 males and 10 females) aged 13 +/- 3.5 years. WCH was defined as systolic and/or diastolic blood pressure (BP) > or =95th percentile for age, sex, and height and with reported normal BP measurements at home. Urinary endothelin (UET1), urinary free cortisol (UFC), and plasma renin levels were determined by radioimmunoassay; and urinary albumin levels were determined by nephelometry. For statistical analysis, the Mann Whitney U test, Spearman correlation coefficient, and multivariate analysis of variance/multivariate analysis of covariance were used, as applicable.
The 24-hour values of UET1 and UFC were greater in male subjects with WCH than in male control subjects (P =.02), whereas no such difference was found in female subjects. The difference in UFC values in male subjects was accounted for by the day values. In subjects with WCH, and not in control subjects, a positive correlation of UET1 to UFC (r = 0.59, P =.027), diastolic BP (r = 0.55, P =.04), and mean BP (r = 0.65, P =.012) was detected.
Our data indicate that WCH in adolescence may not be an innocent phenomenon and may represent a prelude to permanent idiopathic hypertension of adulthood.
探讨青少年“白大衣高血压”（WCH）是一种无害现象，还是与血管系统的早期变化和/或应激反应增加有关，分别反映在尿内皮素和皮质醇值上。
研究组包括36名受试者，14名患有WCH（8名男性和6名女性），年龄为12.9±3岁，22名血压正常的对照受试者（12名男性和10名女性），年龄为13±3.5岁。WCH定义为收缩压和/或舒张压（BP）高于或等于年龄、性别和身高的第95百分位数，且在家中测得的血压正常。通过放射免疫测定法测定尿内皮素（UET1）、尿游离皮质醇（UFC）和血浆肾素水平；通过散射比浊法测定尿白蛋白水平。根据适用情况，使用曼-惠特尼U检验、斯皮尔曼相关系数以及方差多元分析/协方差多元分析进行统计分析。
患有WCH的男性受试者的UET1和UFC的24小时值高于男性对照受试者（P = 0.02），而女性受试者中未发现此类差异。男性受试者UFC值的差异由日间值导致。在患有WCH的受试者中，而非对照受试者中，检测到UET1与UFC（r = 0.59，P = 0.027）、舒张压（r = 0.55，P = 0.04）和平均血压（r = 0.65，P = 0.012）呈正相关。
我们的数据表明，青少年WCH可能不是一种无害现象，可能代表成年期永久性特发性高血压的前奏。
