Siddiqui Mohammed, Judd Eric K, Oparil Suzanne, Calhoun David A
From the Vascular Biology and Hypertension Program, University of Alabama at Birmingham.
Hypertension. 2017 Sep;70(3):645-651. doi: 10.1161/HYPERTENSIONAHA.117.09464. Epub 2017 Jul 10.
Refractory hypertension is a recently described phenotype of antihypertensive treatment failure defined as uncontrolled blood pressure (BP) despite the use of ≥5 different antihypertensive agents, including chlorthalidone and spironolactone. Recent studies indicate that refractory hypertension is uncommon, with a prevalence of ≈5% to 10% of patients referred to a hypertension specialty clinic for uncontrolled hypertension. The prevalence of white-coat effect, that is, uncontrolled automated office BP ≥135/85 mm Hg and controlled out-of-office BP <135/85 mm Hg, by awake ambulatory BP monitor in hypertensive patients overall is ≈30% to 40%. The prevalence of white-coat effect among patients with refractory hypertension has not been previously reported. In this prospective evaluation, consecutive patients referred to the University of Alabama at Birmingham Hypertension Clinic for uncontrolled hypertension were enrolled. Refractory hypertension was defined as uncontrolled automated office BP ≥135/85 mm Hg with the use of ≥5 antihypertensive agents, including chlorthalidone and spironolactone. Automated office BP measurements were based on 6 serial readings, done automatically with the use of a BpTRU device unobserved in the clinic. Out-of-office BP measurements were done by 24-hour ambulatory BP monitor. Thirty-four patients were diagnosed with refractory hypertension, of whom 31 had adequate ambulatory BP monitor readings. White-coat effect was present in only 2 patients, or 6.5% of the 31 patients with refractory hypertension, suggesting that white-coat effect is largely absent in patients with refractory hypertension. These findings suggest that white-coat effect is not a common cause of apparent lack of BP control in patients failing maximal antihypertensive treatment.
难治性高血压是最近描述的一种抗高血压治疗失败的表型，定义为尽管使用了≥5种不同的抗高血压药物（包括氯噻酮和螺内酯），血压仍未得到控制。最近的研究表明，难治性高血压并不常见，在因高血压控制不佳而转诊至高血压专科诊所的患者中，其患病率约为5%至10%。在高血压患者中，通过清醒动态血压监测发现，白大衣效应（即诊室自动血压≥135/85 mmHg且诊室外血压<135/85 mmHg）的总体患病率约为30%至40%。此前尚未报道难治性高血压患者中白大衣效应的患病率。在这项前瞻性评估中，纳入了连续转诊至阿拉巴马大学伯明翰分校高血压诊所的高血压控制不佳的患者。难治性高血压定义为使用≥5种抗高血压药物（包括氯噻酮和螺内酯）时，诊室自动血压≥135/85 mmHg。诊室自动血压测量基于6次连续读数，使用诊所未观察到的BpTRU设备自动完成。诊室外血压测量通过24小时动态血压监测进行。34例患者被诊断为难治性高血压，其中31例有足够的动态血压监测读数。只有2例患者存在白大衣效应，占31例难治性高血压患者的6.5%，这表明难治性高血压患者中很大程度上不存在白大衣效应。这些发现表明，白大衣效应并非最大抗高血压治疗失败患者血压明显控制不佳的常见原因。
