Le Feuvre C, Francillon A, Renucci J F, Cocco-Guyomarch L, Muller M, Peuplier P, Poggi L
Clinique Cardiologique, Hôpital Necker, Paris, France.
Therapie. 1996 Jan-Feb;51(1):27-34.
The aim of this study was to analyse the respective values of clinic and ambulatory blood pressure measurements in patients with treated hypertension. Twenty-eight patients with mild to moderate hypertension were studied (clinic blood pressure > or = 160/95 mmHg), treated with benazepril alone (n = 7) or combined with hydrochlorothiazide (n = 21). A 24 h ambulatory blood pressure measurement was performed before (d0) and after 8 weeks of treatment (d56). The treatment was effective on the ambulatory blood pressure in 19 patients (Staessen criteria) and effective on clinic measurements in 20 patients (WHO criteria). The results were concordant in 25 of the 28 patients. The decrease of the ambulatory blood pressure values during the day between d0 and d56 was not significantly related to the decrease of the clinic values. The comparison of the ambulatory blood pressure values at each hour between d0 and d56 showed that the treatment was effective during 24 h. The 'white coat' effect has been evaluated at d0 and d56 by the difference between mean daytime ambulatory blood pressure and clinic values. Clinic values were higher than mean daytime ambulatory values in benazepril (14 +/- 12 mmHg and 7 +/- 7 mmHg for the systolic and diastolic pressure) and benazepril-hydrochlorothiazide group (12 +/- 12 mmHg and 0.2 +/- 9 mmHg for the systolic and diastolic pressure). This 'white coat' effect was not modified during the treatment. Previous studies have emphasized a better assessment of the cardiovascular risk with ambulatory than with clinic measurements. The differences in the assessment of the efficiency of the treatment between clinic and ambulatory measurements shown in our study prompt us to use ambulatory measurements in patients with apparently uncontrolled hypertension.
本研究旨在分析经治疗的高血压患者临床血压测量值与动态血压测量值各自的价值。对28例轻至中度高血压患者（临床血压≥160/95 mmHg）进行了研究，这些患者单独使用贝那普利治疗（n = 7）或联合氢氯噻嗪治疗（n = 21）。在治疗前（d0）和治疗8周后（d56）进行了24小时动态血压测量。根据施坦森标准，19例患者的动态血压治疗有效，根据世界卫生组织标准，20例患者的临床测量治疗有效。28例患者中有25例结果一致。d0至d56期间日间动态血压值的下降与临床血压值的下降无显著相关性。d0和d56之间每小时动态血压值的比较显示，治疗在24小时内均有效。通过日间平均动态血压值与临床血压值的差值，在d0和d56评估了“白大衣”效应。在贝那普利组（收缩压和舒张压分别为14±12 mmHg和7±7 mmHg）和贝那普利 - 氢氯噻嗪组（收缩压和舒张压分别为12±12 mmHg和0.2±9 mmHg）中，临床血压值高于日间平均动态血压值。治疗期间这种“白大衣”效应未改变。先前的研究强调，与临床测量相比，动态血压测量能更好地评估心血管风险。我们研究中临床测量与动态测量在治疗效果评估上的差异促使我们在明显血压控制不佳的患者中使用动态血压测量。
