Gorostidi Manuel, Vinyoles Ernest, Banegas José R, de la Sierra Alejandro
Department of Nephrology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Red de Investigación Renal REDinREN, Spain.
La Mina Primary Care Center, University of Barcelona, Barcelona, Spain.
Hypertens Res. 2015 Jan;38(1):1-7. doi: 10.1038/hr.2014.149. Epub 2014 Oct 16.
In the past two decades, techniques for the measurement of blood pressure outside the medical setting have unmasked highly prevalent situations. A significant proportion of patients with office blood pressure levels above the thresholds for diagnosing hypertension or above the limits where those being treated are considered to be adequately controlled actually show normal ambulatory blood pressure levels. These patients have white-coat hypertension if untreated or false resistance to antihypertensive therapy because of the white-coat effect if treated. However, some individuals with normal office blood pressure measurements show elevated ambulatory blood pressure levels, and thus have masked hypertension if untreated or masked uncontrolled hypertension if treated. When looking for white-coat hypertension in patients with elevated office blood pressure levels or when looking for masked hypertension in office-controlled patients, up to one in three patients in each scenario would have white-coat or masked hypertension. Although related clinical factors, such as age, gender and global cardiovascular risk, are associated with both conditions, their abilities to predict such a misclassification are very low. Thus, assessing individual blood pressure levels by means of an ambulatory technique, particularly ambulatory blood pressure monitoring, is now considered a priority in diagnosing hypertension and in evaluating hypertension control.
在过去二十年中，医疗环境之外测量血压的技术揭示了一些极为普遍的情况。相当一部分患者的诊室血压水平高于高血压诊断阈值，或者高于接受治疗者被认为得到充分控制的界限，但实际上其动态血压水平正常。这些患者若未接受治疗，则患有白大衣高血压；若接受治疗，则因白大衣效应而对降压治疗表现出假性抵抗。然而，一些诊室血压测量正常的个体却显示动态血压水平升高，因此若未接受治疗则患有隐匿性高血压，若接受治疗则患有隐匿性未控制高血压。在诊室血压升高的患者中寻找白大衣高血压，或在诊室血压得到控制的患者中寻找隐匿性高血压时，每种情况下多达三分之一的患者会患有白大衣或隐匿性高血压。尽管年龄、性别和总体心血管风险等相关临床因素与这两种情况均有关联，但其预测这种分类错误的能力非常低。因此，现在认为通过动态技术，尤其是动态血压监测来评估个体血压水平，是诊断高血压和评估高血压控制情况的首要任务。
