Björklund Kristina, Lind Lars, Vessby Bengt, Andrén Bertil, Lithell Hans
Department of Public Health and Caring Sciences/Section of Geriatrics, University of Uppsala, Sweden.
Circulation. 2002 Jul 2;106(1):63-8. doi: 10.1161/01.cir.0000019737.87850.5a.
The clinical significance of white-coat hypertension is still unclear. Moreover, no study has examined metabolic predictors of white-coat versus sustained hypertension.
We investigated men (n=602) in a longitudinal population-based cohort who at age 70 years were identified as normotensive, white-coat hypertensive (office blood pressure [BP] > or =140/90 and daytime ambulatory BP <135/85 mm Hg), and sustained hypertensive (office BP > or =140/90 and daytime ambulatory BP > or =135/85 mm Hg). At baseline, when the subjects were aged 50 years, blood glucose, insulin, lipids, and fatty acid composition of the serum cholesterol esters were analyzed. The investigations at age 70 years included determination of insulin sensitivity and target organ damage. At age 50 years, individuals who 20 years later were identified as white-coat hypertensive or sustained hypertensive showed significantly elevated BP, heart rate, and impaired glucose tolerance compared with normotensive subjects but white coat hypertensive subjects were leaner and had a more favorable serum cholesterol ester fatty acid profile than did sustained hypertensive subjects. At age 70 years, both white-coat and sustained hypertensive subjects showed an impaired insulin sensitivity, elevated blood glucose, and increased serum insulin and heart rate compared with normotensive subjects, but left ventricular mass and urinary albumin excretion were increased only in sustained hypertensive subjects.
These findings indicate that although metabolic abnormalities and elevated heart rate were consistent over time in both hypertensive groups, a lower body mass index and more favorable dietary fat composition predicted the development of white-coat as opposed to sustained hypertension over 20 years.
白大衣高血压的临床意义仍不明确。此外，尚无研究探讨白大衣高血压与持续性高血压的代谢预测因素。
我们在一项基于人群的纵向队列研究中调查了602名男性，这些男性在70岁时被确定为血压正常、白大衣高血压（诊室血压[BP]≥140/90且日间动态血压<135/85 mmHg）和持续性高血压（诊室血压≥140/90且日间动态血压≥135/85 mmHg）。在基线时，即受试者50岁时，分析其血糖、胰岛素、血脂以及血清胆固醇酯的脂肪酸组成。70岁时的调查包括胰岛素敏感性和靶器官损害的测定。50岁时，20年后被确定为白大衣高血压或持续性高血压的个体与血压正常的受试者相比，血压、心率显著升高，糖耐量受损，但白大衣高血压受试者比持续性高血压受试者更瘦，血清胆固醇酯脂肪酸谱更有利。70岁时，与血压正常的受试者相比，白大衣高血压和持续性高血压受试者均表现出胰岛素敏感性受损、血糖升高、血清胰岛素和心率增加，但仅持续性高血压受试者的左心室质量和尿白蛋白排泄增加。
这些发现表明，尽管两个高血压组的代谢异常和心率升高随时间推移是一致的，但较低的体重指数和更有利的膳食脂肪组成可预测20年内白大衣高血压而非持续性高血压的发生。
