白大衣效应与诊室血压和日间血压的差异无关，且与对公开演讲的更大反应性相关。

The white-coat effect is unrelated to the difference between clinic and daytime blood pressure and is associated with greater reactivity to public speaking.

作者信息

Palatini Paolo, Palomba Daniela, Bertolo Olivo, Minghetti Rita, Longo Daniele, Sarlo Michela, Pessina Achille C

机构信息

Department of Clinical and Experimental Medicine, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.

出版信息

J Hypertens. 2003 Mar;21(3):545-53. doi: 10.1097/00004872-200303000-00020.

DOI:10.1097/00004872-200303000-00020

PMID:12640248

Abstract

OBJECTIVE

To compare the blood pressure (BP) response to doctor's visit with the BP reaction to a psycho-social challenge and with the difference between clinic and daytime BP (DeltaC-D).

SUBJECTS

We studied 64 young stage-1 hypertensive subjects and 33 normotensive controls.

MAIN OUTCOME MEASURES

Relationship between direct and surrogate measure of white-coat effect (WCE) and assessment of BP response to public speaking in subjects with normal or increased reaction to BP measurement.

METHODS

The responses to BP measurement by a doctor and to public speaking were assessed with beat-to-beat Finapres recording. DeltaC-D was calculated on the basis of two BP monitorings and used as a surrogate measure of WCE.

RESULTS

BP and heart rate changes elicited by the visit were unrelated to DeltaC-D and were correlated to the changes caused by the speech test [P <0.001 for systolic BP (SBP), P = 0.01 for diastolic BP (DBP), and P <0.001 for heart rate]. Hypertensive subjects with SBP response to doctor's visit above the median (hyper-reactive) showed increased reactivity also to public speaking (61 +/- 15 mmHg), while those with BP response below the median (normo-reactive) had a response to the psycho-social challenge (40 +/- 21 mmHg, 0.001 versus hyper-reactive) similar to that of the normotensive controls (38 +/- 17 mmHg). Epinephrine urinary output was greater in the hyper-reactive than the normo-reactive subjects (23 versus 12 microg/24 h, = 0.01). The SBP response to public speaking was greater in the hypertensive subjects with higher systolic daytime BP than in those with lower daytime BP (55.3 +/- 20.9 versus 45.1 +/- 20.6 mmHg, = 0.046).

CONCLUSIONS

Subjects with increased WCE have an exaggerated response also to psycho-social stimuli. Average daytime BP, which incorporates the BP reactions to many psycho-social triggers can, thus, not be taken as the basal BP of an individual. This helps explain why DeltaC-D does not reflect the true WCE.

摘要

目的

比较就诊时的血压（BP）反应与心理社会应激挑战时的血压反应，以及诊室血压与日间血压差值（DeltaC-D）。

对象

我们研究了64例年轻的1期高血压患者和33例血压正常的对照者。

主要观察指标

白大衣效应（WCE）的直接测量指标与替代测量指标之间的关系，以及血压测量反应正常或增强的受试者对公众演讲的血压反应评估。

方法

采用逐搏Finapres记录法评估医生测量血压和公众演讲时的反应。DeltaC-D基于两次血压监测计算得出，并用作WCE的替代测量指标。

结果

就诊引起的血压和心率变化与DeltaC-D无关，与言语测试引起的变化相关[收缩压（SBP）P<0.001，舒张压（DBP）P = 0.01，心率P<0.001]。就诊时SBP反应高于中位数的高血压患者（高反应性）对公众演讲的反应性也增强（61±15 mmHg），而血压反应低于中位数的患者（正常反应性）对心理社会应激挑战的反应（40±21 mmHg，与高反应性相比P = 0.001）与血压正常的对照者（38±17 mmHg）相似。高反应性受试者的肾上腺素尿排泄量高于正常反应性受试者（23对12μg/24 h，P = 0.01）。日间收缩压较高的高血压患者对公众演讲的SBP反应高于日间收缩压较低的患者（55.3±20.9对45.1±20.6 mmHg，P = 0.046）。