中年人群中心血管危险因素与家庭血压记录诊断的白大衣性高血压之间的关系。
Relationships between cardiovascular risk factors and white-coat hypertension diagnosed by home blood pressure recordings in a middle-aged population.
机构信息
Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
出版信息
J Hypertens. 2021 Oct 1;39(10):2009-2014. doi: 10.1097/HJH.0000000000002888.
OBJECTIVE
To study risk in white-coat hypertension (WCH) by measurement of coronary artery calcium score (CACS), carotid--femoral pulse-wave velocity (PWV) and carotid plaques.
METHODS
Cross-sectional population-based cohort with randomized selection of participants from Linköping, Sweden. An Omron m10-IT oscillometric device was used for clinic and home blood pressures (HBP) in the morning and evening for 1 week.
RESULTS
We recruited 5029 middle-aged and mainly defined WCH as SBP at least 140 mmHg and/or DBP at least 90 mmHg with HBP less than 135/85 mmHg. There were 2680 normotensive participants and 648 had WCH after exclusion of treated participants. More women (59.5%) than men (42.8%, P < 0.001) had WCH. We found higher prevalence of CACS greater than 100 compared with less than 100 (12.4 vs. 7.2%, P < 0.001), PWV (11.5 ± 1.5 vs. 10.4 ± 1.3 m/s, P < 0.001) and a higher prevalence of one or more carotid plaques (59.5 vs. 48%, P < 0.001) in participants with WCH than in normotension. Participants with WCH also had more dyslipidemia and higher glucose levels. Normotensive women scored lower on nervousness than women with WCH (P = 0.022). After matching of 639 participants with WCH to normotensive participants according to age, gender and systolic HBP the prevalence of a high CACS (12.1 vs. 8.6%, P = 0.003,) PWV (11.0 ± 0.068 vs. 11.5 ± 0.068 m/s, estimated marginal means ± SE, P < 0.001 by ANOVA) but not more carotid plaques (59.5 vs. 55.6%, P = 0.23), remained in the participants with WCH compared with the matched normotensive participants.
CONCLUSION
WCH is particularly common in middle-aged women, and it displays metabolic dysfunction and increased prevalence of arteriosclerotic manifestations in both genders. As markers of increased cardiovascular risk were present also after matching normotensive and WCH participants according to systolic HBP, age and gender, the presence of WCH signals an increased cardiovascular risk burden that is not fully explained by elevated BP levels at home.
目的
通过测量冠状动脉钙评分（CACS）、颈动脉-股动脉脉搏波速度（PWV）和颈动脉斑块来研究白大衣高血压（WCH）的风险。
方法
这是一项基于人群的横断面研究，参与者来自瑞典林雪平，采用随机抽样的方式选择。使用欧姆龙 m10-IT 振荡式设备在早上和晚上进行为期一周的诊所和家庭血压（HBP）测量。
结果
我们招募了 5029 名中年参与者，主要将 SBP 至少 140mmHg 和/或 DBP 至少 90mmHg 且 HBP 低于 135/85mmHg 的患者定义为 WCH。有 2680 名血压正常的参与者，在排除接受治疗的参与者后，有 648 名患有 WCH。与男性（42.8%）相比，女性（59.5%）更容易患有 WCH（P<0.001）。我们发现，与 CACS 小于 100 的患者相比，CACS 大于 100 的患者的患病率更高（12.4%比 7.2%，P<0.001），PWV（11.5±1.5 比 10.4±1.3m/s，P<0.001）和颈动脉斑块数量超过一个的比例更高（59.5%比 48%，P<0.001）。与血压正常的参与者相比，WCH 患者的血脂异常和血糖水平更高。与 WCH 女性相比，血压正常的女性神经质评分更低（P=0.022）。根据年龄、性别和收缩压 HBP ，对 639 名 WCH 患者和血压正常的患者进行匹配后，WCH 患者的高 CACS（12.1%比 8.6%，P=0.003）、PWV（11.0±0.068 比 11.5±0.068m/s，估计边缘均值±SE，通过方差分析，P<0.001）的患病率仍然较高，但颈动脉斑块的患病率（59.5%比 55.6%，P=0.23）则没有更高。
结论
WCH 在中年女性中尤为常见，其表现为代谢功能障碍，且无论性别，动脉粥样硬化表现的患病率均升高。在根据收缩压 HBP、年龄和性别匹配血压正常和 WCH 患者后，仍存在心血管风险增加的标志物，这表明 WCH 不仅与家庭血压升高有关，还与心血管风险负担增加有关。
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