Longo Daniele, Zaetta Vania, Perkovic Davor, Frezza Paola, Ragazzo Fabio, Mos Lucio, Santonastaso Massimo, Garbelotto Raffaella, Benetos Athanase, Palatini Paolo
Clinica Medica 4, University of Padova, Town Hospital, San Daniele del Friuli, Vittorio Veneto, Italy.
Blood Press Monit. 2006 Oct;11(5):243-9. doi: 10.1097/01.mbp.0000209083.47740.35.
Conflict still exists over whether patients with white-coat hypertension are at increased risk of developing target organ damage compared with normotensive individuals.
We studied vascular distensibility in 117 young-to-middle age patients with white-coat hypertension, 174 patients with sustained hypertension, and 51 normotensive controls. To obtain a measure of compliance, a model was used that divides the total systemic compliance into large artery (C1) and small artery (C2) compliance. With this aim, radial arterial pulse waves were recorded with a tonometer sensor array by means of an HDI CR2000 device (Eagan, Minnesota, USA). Moreover, pulse wave velocity and the augmentation index were measured using the Specaway DAT system (St Pauls, Sydney, Australia).
Patients with sustained hypertension had a greater body mass index than patients with white-coat hypertension (P=0.04) or the normotensive individuals (P=0.01). C1 and C2 were decreased in the two hypertensive groups as compared with those in the normotensive group (P=0.0002 and 0.03, respectively, versus sustained hypertension; P=0.00007 and 0.0004, respectively, versus white-coat hypertension). Pulse wave velocity and aortic augmentation index were increased in the white-coat hypertension patients compared with the normotensive individuals (P=0.02 and 0.004, respectively). Aortic augmentation index (P=0.008) but not pulse wave velocity was increased in the sustained hypertensive patients compared with that in the normotensive individuals. All indexes of arterial distensibility were similar in the two hypertensive groups.
Indexes of arterial distensibility are impaired in the white-coat hypertensive group and similar to those in the sustained hypertensive group, indicating that early changes in the arterial wall can occur in white-coat hypertension. This may account for the higher risk of stroke that has been described in this condition.
与血压正常者相比，白大衣高血压患者发生靶器官损害的风险是否增加仍存在争议。
我们研究了117例中青年白大衣高血压患者、174例持续性高血压患者和51例血压正常对照者的血管扩张性。为了获得顺应性的测量值，使用了一种将总全身顺应性分为大动脉（C1）和小动脉（C2）顺应性的模型。为此，通过HDI CR2000设备（美国明尼苏达州伊根）用压力传感器阵列记录桡动脉脉搏波。此外，使用Specaway DAT系统（澳大利亚悉尼圣保罗）测量脉搏波速度和增强指数。
持续性高血压患者的体重指数高于白大衣高血压患者（P = 0.04）或血压正常者（P = 0.01）。与血压正常组相比，两个高血压组的C1和C2均降低（与持续性高血压相比，P分别为0.0002和0.03；与白大衣高血压相比，P分别为0.00007和0.0004）。与血压正常者相比，白大衣高血压患者的脉搏波速度和主动脉增强指数增加（分别为P = 0.02和0.004）。与血压正常者相比，持续性高血压患者的主动脉增强指数（P = 0.008）升高，但脉搏波速度未升高。两个高血压组的动脉扩张性指标相似。
白大衣高血压组动脉扩张性指标受损，与持续性高血压组相似，表明白大衣高血压可发生动脉壁早期改变。这可能解释了这种情况下所描述的中风风险较高的原因。
