From the Department of Nephrology and Hypertension, University Hospital of Erlangen, Erlangen, Germany (R.E.S., S.T.S.); Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany (T.R., J.S., U.Z.); Medical Klinik B, Hospital of the City of Ludwigshafen, Ludwigshafen, Germany (U.Z.); Department of Molecular and Clinical Cardiology, Charité University Hospital Berlin, Berlin, Germany (R.D.); Clinical and Regulatory Affairs, Novartis Pharma GmbH, Nuremberg, Germany (I.H.); and Division of Cardiology, St Luke's Roosevelt Hospital, Columbia University, New York, NY (F.H.M.).
Hypertension. 2014 Nov;64(5):1067-72. doi: 10.1161/HYPERTENSIONAHA.113.03140. Epub 2014 Aug 4.
The long-term relationship between 24-hour ambulatory blood pressure (ABP) and office BP in patients on therapy is not well documented. From a registry we included all patients in whom antihypertensive therapy needed to be uptitrated. Drug treatment included the direct renin inhibitor aliskiren or an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker or drugs not blocking the renin-angiotensin system, alone or on top of an existing drug regimen. In all patients, office BP and 24-hour ABP were obtained at baseline and after 1 year with validated devices. In the study population of 2722 patients, there was a good correlation between the change in office BP and 24-hour ABP (systolic: r=0.39; P<0.001; diastolic: r=0.34; P<0.001). However, the numeric decrease in office BP did not correspond to the decrease in ABP in a 1:1 fashion, for example, a decrease of 10, 20, and 30 mm Hg corresponded to a decrease of ≈7.2, 10.5, and 13.9 mm Hg in systolic ABP, respectively. The disproportionally greater decrease in systolic office BP compared with ABP was dependent on the level of the pretreatment BP, which was consistently higher for office BP than ABP. The white coat effect (difference between office BP and ABP) was on average 10/5 mm Hg lower 1 year after intensifying treatment and the magnitude of that was also dependent on pretreatment BP. There was a disproportionally greater decrease in systolic office BP than in ABP, which for both office BP and ABP seemed to depend on the pretreatment BP level.
在接受治疗的患者中，24 小时动态血压（ABP）与诊室血压之间的长期关系尚未得到充分证实。我们从一个登记处中纳入了所有需要调整降压治疗的患者。药物治疗包括直接肾素抑制剂阿利克仑或血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂，或不阻断肾素-血管紧张素系统的药物，单独或在现有药物治疗方案的基础上加用。在所有患者中，在基线时和 1 年后使用经过验证的设备获得诊室血压和 24 小时 ABP。在 2722 例患者的研究人群中，诊室血压变化与 24 小时 ABP 之间存在良好的相关性（收缩压：r=0.39；P<0.001；舒张压：r=0.34；P<0.001）。然而，诊室血压的数值下降与 ABP 的下降并不呈 1:1 对应关系，例如，收缩压下降 10、20 和 30mmHg 分别对应于 ABP 下降约 7.2、10.5 和 13.9mmHg。与 ABP 相比，诊室收缩压不成比例地更大程度下降，这取决于治疗前血压水平，诊室血压始终高于 ABP。“白大衣效应”（诊室血压与 ABP 之间的差异）在强化治疗 1 年后平均降低 10/5mmHg，且该差异幅度也取决于治疗前的血压水平。诊室收缩压下降幅度大于 ABP，这种不成比例的下降似乎与治疗前的血压水平有关。
