Sipahioglu Nurver Turfaner, Sipahioglu Fikret
Nurver Turfaner Sipahioglu, Fikret Sipahioglu, Department of Family Medicine, Cerrahpasa Medical Faculty, Istanbul University, 34303 Istanbul, Turkey.
World J Methodol. 2014 Sep 26;4(3):144-50. doi: 10.5662/wjm.v4.i3.144.
This review aims to clarify novel concepts regarding the clinical and laboratory aspects of white-coat hypertension (WCHT). Recent studies on the clinical and biological implications of WCHT were compared with existing knowledge. Studies were included if the WCHT patients were defined according to the 2013 European Society of Hypertension guidelines, i.e., an office blood pressure (BP) of ≥ 140/90 mmHg, a home BP of ≤ 135/85 mmHg, and a mean 24-h ambulatory BP of ≤ 130/80 mmHg. WCHT studies published since 2000 were selected, although a few studies performed before 2000 were used for comparative purposes. True WCHT was defined as normal ABPM and home BP readings, and partial WCHT was defined as an abnormality in one of these two readings. The reported prevalence of WCHT was 15%-45%. The incidence of WCHT tended to be higher in females and in non-smokers. Compared with normotensive (NT) patients, WCHT was associated with a higher left ventricular mass index, higher lipid levels, impaired fasting glucose, and decreased arterial compliance. The circadian rhythm in WCHT patients was more variable than in NT patient's, with a higher pulse pressure and non-dipping characteristics. Compared with sustained hypertension patients, WCHT patients have a better 10-year prognosis; compared with NT patients, WCHT patients have a similar stroke risk, but receive more frequent drug treatment. There are conflicting results regarding WCHT and markers of endothelial damage, oxidative stress and inflammation, and the data imply that WCHT patients may have a worse prognosis. Nitric oxide levels are lower, and oxidative stress parameters are higher in WCHT patients than in NT patients, whereas the antioxidant capacity is lower in WCHT patients than in NT patients. Clinicians should be aware of the risk factors associated with WCHT and patients should be closely monitored especially to identify target organ damage and metabolic syndrome.
本综述旨在阐明有关白大衣高血压（WCHT）临床和实验室方面的新概念。将近期关于WCHT临床和生物学意义的研究与现有知识进行了比较。如果WCHT患者是根据2013年欧洲高血压学会指南定义的，即诊室血压（BP）≥140/90 mmHg，家庭血压≤135/85 mmHg，以及24小时动态平均血压≤130/80 mmHg，则纳入研究。选取了2000年以来发表的WCHT研究，不过也使用了一些2000年之前进行的研究用于比较目的。真正的WCHT定义为动态血压监测（ABPM）和家庭血压读数正常，部分WCHT定义为这两个读数之一异常。报道的WCHT患病率为15% - 45%。WCHT的发病率在女性和非吸烟者中往往更高。与血压正常（NT）患者相比，WCHT与更高的左心室质量指数、更高的血脂水平、空腹血糖受损和动脉顺应性降低有关。WCHT患者的昼夜节律比NT患者更具变异性，脉压更高且有非勺型特征。与持续性高血压患者相比，WCHT患者有更好的10年预后；与NT患者相比，WCHT患者有相似的中风风险，但接受药物治疗更频繁。关于WCHT与内皮损伤、氧化应激和炎症标志物存在相互矛盾的结果，数据表明WCHT患者可能预后更差。WCHT患者的一氧化氮水平低于NT患者，氧化应激参数高于NT患者，而WCHT患者的抗氧化能力低于NT患者。临床医生应意识到与WCHT相关的危险因素，并且应密切监测患者，特别是要识别靶器官损害和代谢综合征。
