Silveira Albino, Mesquita Anabela, Maldonado João, Silva José Alberto, Polónia Jorge
Unidade Hipertensão e Risco Cardiovascular, Hospital Pedro Hispano, Matosinhos Unidade Farmacologia Clínica da Faculdade de Medicina do Porto.
Rev Port Cardiol. 2002 May;21(5):517-30.
To evaluate in hypertensive patients whether the white coat effect is associated with target-organ damage and whether it is modified by anti-hypertensive therapy.
In a cross-sectional study we evaluated blood pressure (BP) measured in the office and by 24-h ambulatory blood pressure monitoring (ABPM), carotid-femoral pulse wave velocity (PWV) as an index of aortic stiffness, and left ventricular mass index (LVMI) in 88 subjects (aged 49 +/- 2 years) with white-coat hypertension (WCH, office BP > 140/90, daytime BP < 130/84 mmHg), 31 under antihypertensive therapy, 57 untreated, and in 115 patients with office and ambulatory hypertension (HT, aged 51 +/- 2 years, office BP > 140/90, daytime BP > 135/85), 65 under antihypertensive therapy, 50 untreated. In a longitudinal study in 15 patients with HT and in 11 patients with WCH we evaluated the influence of antihypertensive therapy (> 6 months) on office and ambulatory BP and on PWV.
The intensity of the white coat effect (office BP-daytime BP) was greater in WCH than in HT. Taking all subjects, the white coat effect did not correlate with PWV (r = 0.08, ns) or with LVMI (r = 0.01, ns), whereas daytime BP correlated significantly with PWV (r = 0.41, p < 0.01) and with LVMI (r = 0.32, p < 0.05). WCH subjects showed lower PWV and LVMI than HT subjects. Treated and untreated WCH, with similar office and daytime BP, showed similar values of PWV and LVMI. Treated and untreated HT showed similar office BP values but treated HT showed lower daytime BP and PWV values. In the longitudinal study, antihypertensive therapy significantly reduced daytime BP and PWV values in the 15 HTs, whereas in the 11 WCH it did not alter daytime BP or PWV values.
评估高血压患者的白大衣效应是否与靶器官损害相关，以及抗高血压治疗是否会改变该效应。
在一项横断面研究中，我们评估了88名白大衣高血压（WCH，诊室血压>140/90，日间血压<130/84 mmHg）受试者（年龄49±2岁）的诊室血压和24小时动态血压监测（ABPM）测量的血压、作为主动脉僵硬度指标的颈股脉搏波速度（PWV）以及左心室质量指数（LVMI），其中31名接受抗高血压治疗，57名未治疗；还评估了115名诊室和动态高血压（HT，年龄51±2岁，诊室血压>140/90，日间血压>135/85）患者的上述指标，其中65名接受抗高血压治疗，50名未治疗。在一项针对15名HT患者和11名WCH患者的纵向研究中，我们评估了抗高血压治疗（>6个月）对诊室和动态血压以及PWV的影响。
WCH患者的白大衣效应强度（诊室血压 - 日间血压）大于HT患者。在所有受试者中，白大衣效应与PWV（r = 0.08，无统计学意义）或LVMI（r = 0.01，无统计学意义）均无相关性，而日间血压与PWV（r = 0.41，p < 0.01）和LVMI（r = 0.32，p < 0.05）显著相关。WCH受试者的PWV和LVMI低于HT受试者。接受治疗和未接受治疗的WCH患者，诊室和日间血压相似，PWV和LVMI值也相似。接受治疗和未接受治疗的HT患者诊室血压值相似，但接受治疗的HT患者日间血压和PWV值较低。在纵向研究中，抗高血压治疗显著降低了15名HT患者的日间血压和PWV值，而在11名WCH患者中，抗高血压治疗未改变日间血压或PWV值。
