Muxfeldt Elizabeth S, Bloch Katia V, Nogueira Armando R, Salles Gil F
Internal Medicine Unit, University Hospital Clementino Fraga Filho, Rio de Janeiro, Brazil.
Blood Press Monit. 2003 Oct;8(5):181-5. doi: 10.1097/00126097-200310000-00001.
Ambulatory blood pressure monitoring (ABPM) is a tool to diagnose resistant hypertension (RH). The objective of this study is to describe the pattern of 24-h ABPM in patients using at least three anti hypertensive drugs without blood pressure (BP) control, classifying them as true RH or white-coat RH.
A cross-sectional study involving resistant hypertensives that were submitted to clinical, laboratory and 2D-echocardiographic evaluation. Ambulatory blood pressure monitoring was used to diagnose true or white-coat RH. The chi-squared test was used for comparisons among categorical variables and Kruskall-Wallis test for continuous ones.
Of the 286 patients, 161 (56.3%) were classified as true RH and 125 (43.7%) as white-coat RH. Sex, age, office BP and the cardiovascular risk factors for both groups were similar. True resistant hypertensives had more target organ damage then white-coat resistant hypertensives; nephropathy (40.1 versus 23.9%, P=0.007) and left ventricular hypertrophy (83.3 versus 76.3%, P=0.05). In ABPM, the true RH group had a smaller nocturnal systolic and diastolic BP reduction (6.4+/-8.8 versus 9.8+/-7.5 mmHg, P=0.0004; 10.4+/-9.6 versus 13.6+/-9.2 mmHg, P=0.001) and 68.7% of them were non-dippers versus 49.6% in the white-coat RH group (P=0.001). True RH also had a larger 24 h pulse pressure (65.8+/-13.7 versus 51.5+/-10.0 mmHg, P < 0.0001).
Ambulatory blood pressure monitoring is a fundamental tool to diagnose RH, and to check treatment efficacy. The presence of a greater pulse pressure and a lower nocturnal blood pressure reduction in true RH patients may be responsible for this increased cardiovascular risk profile.
动态血压监测（ABPM）是诊断顽固性高血压（RH）的一种工具。本研究的目的是描述使用至少三种抗高血压药物但血压仍未得到控制的患者的24小时ABPM模式，将他们分类为真正的RH或白大衣性RH。
一项横断面研究，纳入接受临床、实验室和二维超声心动图评估的顽固性高血压患者。采用动态血压监测来诊断真正的或白大衣性RH。卡方检验用于分类变量之间的比较，而Kruskal-Wallis检验用于连续变量的比较。
在286例患者中，161例（56.3%）被分类为真正的RH，125例（43.7%）为白大衣性RH。两组的性别、年龄、诊室血压和心血管危险因素相似。真正的顽固性高血压患者比白大衣性顽固性高血压患者有更多的靶器官损害；肾病（40.1%对23.9%，P=0.007）和左心室肥厚（83.3%对76.3%，P=0.05）。在ABPM中，真正的RH组夜间收缩压和舒张压下降幅度较小（6.4±8.8对9.8±7.5 mmHg，P=0.0004；10.4±9.6对13.6±9.2 mmHg，P=0.001），其中68.7%为非勺型血压，而白大衣性RH组为49.6%（P=0.001）。真正的RH患者24小时脉压也更大（65.8±13.7对51.5±10.0 mmHg，P<0.0001）。
动态血压监测是诊断RH和检查治疗效果的重要工具。真正的RH患者脉压更大且夜间血压下降幅度更低，这可能是其心血管风险增加的原因。
