Manios Efstathios D, Koroboki Eleni A, Tsivgoulis Georgios K, Spengos Konstantinos M, Spiliopoulou Ioanna K, Brodie Fiona G, Vemmos Konstantinos N, Zakopoulos Nikolaos A
Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece.
Am J Hypertens. 2008 Feb;21(2):153-8. doi: 10.1038/ajh.2007.43. Epub 2008 Jan 3.
The transient blood pressure (BP) rise during clinical visits is usually referred to as white-coat effect (WCE). The aim of the present study was to investigate factors that may influence the WCE.
A total of 2004 subjects underwent office BP measurements and 24-h ambulatory BP monitoring (ABPM) on the same day. The WCE was estimated as the difference between office and average daytime ambulatory BP (ABP). According to the office and daytime BP values, the study population was divided into normotensives (NTs), white-coat hypertensives (WCHs), masked hypertensives (MHTs), and sustained hypertensives (SHTs). Statistical analyses were performed using one-way analysis of variance and multiple linear regression models.
The mean systolic and diastolic WCE was 9 +/- 16 and 7 +/- 12 mm Hg, respectively. In the entire group of patients, multiple linear regression models revealed independent determinants of systolic WCE in the following rank order: office systolic BP (SBP) (beta = 0.727; P < 0.001), female gender (beta = 0.166; P < 0.001), daytime SBP variability (beta = 0.128; P < 0.001), age (beta = 0.039, P = 0.020), and smoking (beta = 0.031, P = 0.048). A 1.0 mm Hg increase in daytime SBP variability correlated with an increment of 0.589 mm Hg (95% confidence intervals, 0.437-0.741) in the systolic WCE. The regression analyses for diastolic WCE revealed the same factors as independent determinants. A 1.0 mm Hg increase in daytime diastolic BP (DBP) variability was independently associated with an increment of 0.418 mm Hg (95% confidence intervals, 0.121-0.715) in the diastolic WCE.
Factors such as gender, age, smoking, office BPV and daytime BPV may exert an important influence on the magnitude of the WCE.
临床就诊期间血压（BP）的短暂升高通常被称为白大衣效应（WCE）。本研究的目的是调查可能影响白大衣效应的因素。
共有2004名受试者在同一天接受了诊室血压测量和24小时动态血压监测（ABPM）。白大衣效应通过诊室血压与日间平均动态血压（ABP）之间的差值来估计。根据诊室血压和日间血压值，将研究人群分为血压正常者（NTs）、白大衣高血压患者（WCHs）、隐匿性高血压患者（MHTs）和持续性高血压患者（SHTs）。使用单因素方差分析和多元线性回归模型进行统计分析。
收缩压和舒张压的白大衣效应平均值分别为9±16和7±12mmHg。在整个患者组中，多元线性回归模型按以下顺序揭示了收缩压白大衣效应的独立决定因素：诊室收缩压（SBP）（β = 0.727；P < 0.001）、女性（β = 0.166；P < 0.001）、日间收缩压变异性（β = 0.128；P < 0.001）、年龄（β = 0.039，P = 0.020）和吸烟（β = 0.031，P = 0.048）。日间收缩压变异性每增加1.0mmHg，收缩压白大衣效应增加0.589mmHg（95%置信区间，0.437 - 0.741）。舒张压白大衣效应的回归分析显示相同的因素为独立决定因素。日间舒张压（DBP）变异性每增加1.0mmHg，舒张压白大衣效应独立增加0.418mmHg（95%置信区间，0.121 - 0.715）。
性别、年龄、吸烟、诊室血压变异性和日间血压变异性等因素可能对白大衣效应的大小产生重要影响。
