Hypertension Center, STRIDE Hellas-7, Third University Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece.
Hypertens Res. 2014 Sep;37(9):791-5. doi: 10.1038/hr.2014.35. Epub 2014 Mar 6.
White-coat hypertension is defined by elevated office and normal out-of-office blood pressure (home or ambulatory) in untreated subjects. This condition is common in clinical practice and requires appropriate work-up for detection and management. Many studies have examined the relationship between white-coat hypertension and cardiovascular risk but with marked heterogeneity in the definitions and methodology applied. Thus, the results have been inconsistent leading to confusion in scientific research and clinical practice. Some but not all the relevant studies suggested that white-coat hypertension is associated with subclinical target-organ damage, yet the cross-sectional design of these studies and the fact that these indices are only surrogate end points do not allow firm conclusions to be drawn. In recent years, longitudinal studies have examined the prognostic significance of white-coat hypertension in terms of cardiovascular morbidity and mortality. Most of them indicate that white-coat hypertensive compared with normotensive subjects present a moderate-in most cases not significant-increase in risk. Meta-analyses of raw data from large databases, such as the International Database on Ambulatory blood pressure and Cardiovascular Outcomes (IDACO) and the International Database on HOme blood pressure in relation to Cardiovascular Outcomes (IDHOCO) allowed separate powered analyses in untreated subjects and provided a clearer picture regarding the modest risk associated with white-coat hypertension, especially in the long term. White-coat hypertension is regarded as an intermediate phenotype between normotension and hypertension associated with increased risk of developing sustained hypertension, and therefore requires regular follow-up using nonpharmacological measures.
白大衣高血压定义为未经治疗的患者诊室血压升高和（或）家庭或动态血压正常。这种情况在临床实践中很常见，需要进行适当的检查以发现和管理。许多研究已经检查了白大衣高血压与心血管风险之间的关系，但所应用的定义和方法存在明显的异质性。因此，结果不一致，导致科学研究和临床实践中的困惑。一些但不是所有相关研究表明白大衣高血压与亚临床靶器官损害有关，但这些研究的横断面设计以及这些指标只是替代终点，并不能得出确定的结论。近年来，一些纵向研究已经检查了白大衣高血压在心血管发病率和死亡率方面的预后意义。其中大多数表明，与正常血压受试者相比，白大衣高血压患者的风险增加适中——在大多数情况下并不显著。来自大型数据库（如国际动态血压与心血管结局数据库[IDACO]和国际家庭血压与心血管结局数据库[IDHOCO]）的原始数据的荟萃分析允许在未经治疗的患者中进行单独的有力分析，并提供了关于与白大衣高血压相关的适度风险的更清晰的图片，尤其是在长期。白大衣高血压被认为是正常血压和高血压之间的中间表型，与持续高血压发展的风险增加有关，因此需要使用非药物措施进行定期随访。
