非胰岛素依赖型糖尿病患者伴或不伴有早期及显性糖尿病肾病时的白大衣高血压。

White coat hypertension in NIDDM patients with and without incipient and overt diabetic nephropathy.

作者信息

Nielsen F S, Gaede P, Vedel P, Pedersen O, Parving H H

机构信息

Steno Diabetes Center, Gentofte, Denmark.

出版信息

Diabetes Care. 1997 May;20(5):859-63. doi: 10.2337/diacare.20.5.859.

DOI:10.2337/diacare.20.5.859

PMID:9135956

Abstract

OBJECTIVE

Early data have suggested a high prevalence of white coat hypertension (approximately 50%) in NIDDM patients. To study this phenomenon further, we determined the prevalence of white coat hypertension in NIDDM patients with normo- or microalbuminuria or with diabetic nephropathy.

RESEARCH DESIGN AND METHODS

Three groups of hypertensive NIDDM patients (repeated clinic blood pressure > 140/90 mmHg or antihypertensive treatment) attending the Steno Diabetes Center were investigated in a cross-sectional study. Group 1 had normoalbuminuria (a urinary albumin excretion [UAE] rate < 30 mg/24 h, n = 30, age 61 +/- 7 [mean +/- SD] years, 20 men), group 2 had microalbuminuria (UAE rate 30-300 mg/24 h, n = 51, age 55 +/- 7 years, 35 men), and group 3 had diabetic nephropathy (UAE rate > 300 mg/24 h, n = 47, 62 +/- 7 years, 36 men). If given, all previous antihypertensive medication was withdrawn at least 2 weeks before the study (48%). The prevalence of white coat hypertension (clinic hypertension with normal blood pressure values at home) was determined by comparison of clinic blood pressure (Hawksley Random sphygmomanometer) and the ambulatory daytime (7:00 A.M. to 11:00 P.M.) blood pressure (A&D TM2420). By applying established criteria, white coat hypertension was confirmed if daytime blood pressure was < 135/85 mmHg.

RESULTS

The clinic blood pressure was 155/86 (SE 3/2) mmHg, 156/89 (2/1) mmHg, and 171/90 (3/2) mmHg in group 1, 2, and 3, respectively (P < 0.05 comparing group 3 with groups 1 and 2). The prevalence of white coat hypertension was significantly higher in group 1 as compared with groups 2 and 3, 23% (95% CI 10-42) vs. 8% (2-19) and 9% (2-20) (P < 0.05), with no difference between the latter two groups.

CONCLUSIONS

The prevalence of white coat hypertension in normoalbuminuric NIDDM patients resembles that observed in nondiabetic subjects with essential hypertension, whereas the prevalence is significantly lower in NIDDM patients with incipient or overt diabetic nephropathy, suggesting a difference between primary and secondary hypertension.

摘要

目的

早期数据表明，非胰岛素依赖型糖尿病（NIDDM）患者中白大衣高血压的患病率较高（约50%）。为进一步研究这一现象，我们测定了NIDDM患者中伴有正常白蛋白尿或微量白蛋白尿或糖尿病肾病的白大衣高血压的患病率。

研究设计与方法

在一项横断面研究中，对斯滕诺糖尿病中心的三组高血压NIDDM患者（门诊重复血压>140/90 mmHg或接受抗高血压治疗）进行了调查。第1组为正常白蛋白尿（尿白蛋白排泄率<30 mg/24 h，n = 30，年龄61±7[均值±标准差]岁，男性20例），第2组为微量白蛋白尿（尿白蛋白排泄率30 - 300 mg/24 h，n = 51，年龄55±7岁，男性35例），第3组为糖尿病肾病（尿白蛋白排泄率>300 mg/24 h，n = 47，62±7岁，男性36例）。如果患者正在服用抗高血压药物，在研究前至少2周停用（48%）。通过比较门诊血压（Hawksley随机血压计）和日间动态血压（上午7:00至晚上11:00）（A&D TM2420）来确定白大衣高血压（门诊高血压但在家血压值正常）的患病率。根据既定标准，如果日间血压<135/85 mmHg，则确诊为白大衣高血压。

结果

第1、2、3组的门诊血压分别为155/86（标准误3/2）mmHg、156/89（2/1）mmHg和171/90（3/2）mmHg（第3组与第1、第2组比较，P<0.05）。与第2、3组相比，第1组白大衣高血压的患病率显著更高，分别为23%（95%可信区间10 - 42）、8%（2 - 19）和9%（2 - 20）（P<0.05），后两组之间无差异。