Faria João, Mesquita-Bastos Jose, Bertoquini Susana, Silva José, Barbosa Loide, Polónia Jorge
Department Medicine and Cintesis, Faculty of Medicine, University of Porto, Porto.
Health School of Aveiro University, Aveiro.
Blood Press Monit. 2019 Apr;24(2):59-66. doi: 10.1097/MBP.0000000000000364.
The prognostic impact of white-coat hypertension (WCHT) is still a matter of debate and controversy. Night-time blood pressure (NBP) is related strongly to cardiovascular (CV) prognosis, but this has not been considered currently in the definition of WCHT.
We investigated the long-term CV prognosis of 2659 patients submitted at admission to 24 h-ambulatory blood pressure (BP) monitoring divided into three groups: normotension (NT) (n=812; 59% female; ageing 49±13 years), sustained hypertension (SHT) (n=1230; 56% female; ageing 51±13 years) and WCHT (n=617; 55% female; ageing 50±3 years) defined as office BP of at least 140/90 mmHg, daytime BP less than 135/85 mmHg and NBP less than 120/70 mmHg.
The median follow-up was 7.6 years (range: 0.4-24.4), during which a total of 257 CV events (36 fatal) occurred (46% strokes, 32% coronary and 22% others), 38 in NT, 31 in WCHT and 188 in SHT. The event rate per 100 patient-years was 0.60 in the WCHT group, 0.66 in the NT group and 2.09 in the SHT group. Cox's regression analysis adjusted for covariables showed a higher risk of CV events in patients with SHT than WCHT [hazard ratio (HR)=2.230, 95% confidence interval: 1.339-3.716, P=0.002], whereas there was no difference between WCHT and NT groups. Event-free survival was significantly different from SH versus WCHT and NT groups. Within the group of WCHT, 29% of patients received sustained antihypertensive medication during the follow-up, but the HR of CV events between WCHT either treated or not treated did not differ: HR=0.76 (95% confidence interval: 0.37-1.51, P=0.42).
In patients with WCHT defined by normal daytime and NBP values, the risk of CV events was significantly lower than that of SHT and similar to that of NT patients, suggesting that NBP should be included in the WCHT definition and in its prognostic stratification.
白大衣高血压（WCHT）的预后影响仍存在争议。夜间血压（NBP）与心血管（CV）预后密切相关，但目前WCHT的定义中尚未考虑这一点。
我们调查了2659例入院时接受24小时动态血压（BP）监测的患者的长期CV预后，这些患者分为三组：正常血压（NT）组（n = 812；59%为女性；年龄49±13岁）、持续性高血压（SHT）组（n = 1230；56%为女性；年龄51±13岁）和WCHT组（n = 617；55%为女性；年龄50±3岁），WCHT定义为诊室血压至少140/90 mmHg，日间血压低于135/85 mmHg且NBP低于120/70 mmHg。
中位随访时间为7.6年（范围：0.4 - 24.4年），在此期间共发生257例CV事件（36例死亡）（46%为中风，32%为冠心病，22%为其他），NT组38例，WCHT组31例，SHT组188例。WCHT组每100患者年的事件发生率为0.60，NT组为0.66，SHT组为2.09。经协变量调整的Cox回归分析显示，SHT患者发生CV事件的风险高于WCHT患者[风险比（HR）= 2.230，95%置信区间：1.339 - 3.716，P = 0.002]，而WCHT组和NT组之间无差异。无事件生存率在SHT组与WCHT组和NT组之间有显著差异。在WCHT组中，29%的患者在随访期间接受了持续性降压药物治疗，但接受治疗和未接受治疗的WCHT患者发生CV事件的HR无差异：HR = 0.76（95%置信区间：0.37 - 1.51，P = 0.42）。
在日间和NBP值正常定义的WCHT患者中，CV事件风险显著低于SHT患者，与NT患者相似，这表明NBP应纳入WCHT的定义及其预后分层中。
