Stergiou George S, Efstathiou Stamatis P, Argyraki Catherine K, Roussias Leonidas G, Mountokalakis Theodore D
Hypertension Center, Third University Department of Medicine, Sotiria Hospital, 152 Mesogion Avenue, Athens 11527, Greece.
Am J Hypertens. 2004 Feb;17(2):124-8. doi: 10.1016/j.amjhyper.2003.09.016.
Some studies have shown a significant white coat effect (WCE) (i.e., difference between clinic blood pressure [CBP] and awake ambulatory blood pressure [ABP]) to be present not only in untreated but also in treated hypertensive individuals. This study aims to assess 1) the prevalence and the magnitude of the WCE in treated versus untreated hypertensive persons, and 2) the usefulness of home blood pressure (HBP) versus ABP in the detection of this phenomenon.
A case-control study was conducted in 138 treated hypertensive patients and same number of sex- and age-matched untreated hypertensive subjects who had measurements of CBP (at least three visits), HBP, and ABP. Subjects with a WCE of >20/10 mm Hg (systolic/diastolic) were classified as clinic reactors.
There was a trend for a larger WCE assessed by ABP monitoring in the untreated group (mean difference in systolic WCE, 1.8 +/- 22.2 mm Hg, 95% CI -2.0 to 5.5; diastolic 1.8 +/- 11.9 mm Hg, 95% CI -0.2 to 3.8) and for more untreated clinic reactors (27% untreated v 20% treated, odds ratio 1.5, 95% CI 0.9 to 2.7). The sensitivity, specificity, and positive and negative predictive values of HBP to detect clinic reactors correctly were 56%/62% (treated/untreated), 87%/84%, 52%/59%, and 89%/86%, respectively, with moderate agreement between HBP and ABP (kappa 0.42/0.46).
In treated hypertensive patients, WCE seems to be reduced compared with that in untreated hypertensive persons but is not eliminated. In both untreated and treated hypertensive individuals HBP monitoring appears to be useful in the detection of the WCE, but it may not be appropriate as an alternative to the ABP method.
一些研究表明，显著的白大衣效应（WCE）（即诊室血压[CBP]与清醒动态血压[ABP]之间的差异）不仅存在于未治疗的高血压个体中，也存在于已治疗的高血压个体中。本研究旨在评估：1）已治疗与未治疗的高血压患者中WCE的患病率及程度；2）家庭血压（HBP）与ABP在检测该现象方面的效用。
对138例已治疗的高血压患者以及相同数量的性别和年龄匹配的未治疗高血压受试者进行了一项病例对照研究，这些受试者均测量了CBP（至少三次就诊）、HBP和ABP。WCE>20/10 mmHg（收缩压/舒张压）的受试者被归类为诊室反应者。
通过ABP监测评估，未治疗组的WCE有更大的趋势（收缩期WCE的平均差异为1.8±22.2 mmHg，95%CI为-2.0至5.5；舒张期为1.8±11.9 mmHg，95%CI为-0.2至3.8），且未治疗的诊室反应者更多（未治疗组为27%，治疗组为20%，比值比为1.5，95%CI为0.9至2.7）。HBP正确检测诊室反应者的敏感性、特异性、阳性和阴性预测值在治疗组/未治疗组中分别为56%/62%、87%/84%、52%/59%和89%/86%，HBP与ABP之间的一致性一般（kappa值为0.42/0.46）。
与未治疗的高血压患者相比，已治疗的高血压患者的WCE似乎有所降低，但并未消除。在未治疗和已治疗的高血压个体中，HBP监测似乎对检测WCE有用，但它可能不适宜作为ABP方法的替代方法。
