Cavallini M C, Roman M J, Pickering T G, Schwartz J E, Pini R, Devereux R B
Department of Medicine, New York Hospital-Cornell Medical Center, New York 10021, USA.
Hypertension. 1995 Sep;26(3):413-9. doi: 10.1161/01.hyp.26.3.413.
Although white coat hypertension may be present in 20% or more of hypertensive individuals, its prognostic significance is unknown. We compared prognostically relevant measures of target-organ damage among 24 individuals with white coat hypertension and age- and sex-matched groups of sustained hypertensive and normotensive subjects classified by clinical and 24-hour ambulatory blood pressures. Left ventricular and carotid artery structure and function were evaluated by ultrasonography. Left ventricular mass index was similar in white coat hypertensive (82 +/- 17 g/m2) and normotensive (78 +/- 15 g/m2) subjects but was higher in sustained hypertensive subjects (97 +/- 19 g/m2, P < .02 and P < .002, respectively). Similarly, carotid artery intimal-medial thickness was greater in the sustained hypertensive group (0.98 +/- 0.21 mm) than in the white coat hypertensive (0.84 +/- 0.16 mm, P < .05) and normotensive (0.76 +/- 0.18 mm, P < .001) groups. The prevalence of discrete atherosclerotic plaques was higher in the sustained hypertensive group (58%) than in the white coat hypertensive (25%, P < .05) and normotensive (21%, P < .02) groups. Cardiac and carotid structure in individuals with white coat hypertension resemble findings in normotensive subjects and differ significantly from those in age- and sex-matched sustained hypertensive subjects. These findings suggest that white coat hypertension may be a benign condition for which pharmacological intervention may not be necessary, a hypothesis that needs to be tested in longitudinal studies with clinical end points.
尽管在20%或更多的高血压患者中可能存在白大衣高血压，但其预后意义尚不清楚。我们比较了24例白大衣高血压患者以及根据临床和24小时动态血压分类的年龄及性别匹配的持续性高血压和血压正常受试者组中与预后相关的靶器官损害指标。通过超声心动图评估左心室和颈动脉的结构与功能。白大衣高血压患者（82±17g/m²）和血压正常者（78±15g/m²）的左心室质量指数相似，但持续性高血压患者的左心室质量指数更高（97±19g/m²，P分别<.02和<.002）。同样，持续性高血压组的颈动脉内膜中层厚度（0.98±0.21mm）大于白大衣高血压组（0.84±0.16mm，P<.05）和血压正常组（0.76±0.18mm，P<.001）。持续性高血压组中离散性动脉粥样硬化斑块的患病率（58%）高于白大衣高血压组（25%，P<.05）和血压正常组（21%，P<.02）。白大衣高血压患者的心脏和颈动脉结构与血压正常者相似，与年龄及性别匹配的持续性高血压患者有显著差异。这些发现表明，白大衣高血压可能是一种无需药物干预的良性情况，这一假设需要在有临床终点的纵向研究中进行验证。
