Palatini Paolo, Palomba Daniela, Bertolo Olivo, Minghetti Rita, Longo Daniele, Sarlo Michela, Pessina Achille C
Department of Clinical and Experimental Medicine, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
J Hypertens. 2003 Mar;21(3):545-53. doi: 10.1097/00004872-200303000-00020.
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).
We studied 64 young stage-1 hypertensive subjects and 33 normotensive controls.
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.
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.
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).
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.
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）。
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。
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。
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。
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）。
WCE增强的受试者对心理社会刺激的反应也会夸大。包含对多种心理社会触发因素的血压反应的平均日间血压，因此不能被视为个体的基础血压。这有助于解释为什么DeltaC-D不能反映真正的WCE。
