Nyström F, Aardal E, Ohman K P
Department of Internal Medicine, Faculty of Health Sciences, University Hospital, Linköping, Sweden.
Clin Exp Hypertens. 1998 Jan;20(1):95-104. doi: 10.3109/10641969809053209.
We aimed to study the white-coat effect (WCE) of clinic blood pressure (BP) and its relation to plasma cortisol, neuropeptide Y (NPY) and demographic variables. Henry et al. have earlier suggested two stress-reaction patterns. The "defeat reaction" mainly involves the cortisol-axis and the "fight-flight-response" is mediated by the sympathoadrenal-system. Ninety-one men and 88 women 20-70 years of age, randomly selected from the population were recruited in this cross-sectional study. Clinic BP, plasma cortisol and plasma NPY (both analysed by radio-immunoassay) were obtained at 0800 h and 24h ambulatory BP (ABP) was performed. WCE was defined as supine clinic BP - mean daytime ABP. Cortisol correlated to the systolic WCE in the total material* (r = 0.22, p = 0.005) and in men 45-70 years of age (r = 0.45, p = 0.002, n = 47) and to diastolic WCE in women 45-70 years of age* (r = 0.37, p = 0.02, n = 38). (*women treated with oestrogens, or being pregnant, excluded, n = 21). Only in women did NPY correlate weakly to the systolic WCE (r = 0.22, p = 0.044). Subjects with one or more first degree hypertensive relative had a more marked systolic WCE than those without (-0.02 +/- 10 mmHg and -4.1 +/- 9.3 mmHg, respectively, p = 0.01). In conclusion cortisol correlated stronger to the WCE than did NPY. This would suggest the WCE to be a defeat reaction rather than a fight-flight-response.
我们旨在研究诊室血压（BP）的白大衣效应（WCE）及其与血浆皮质醇、神经肽Y（NPY）和人口统计学变量的关系。亨利等人早前提出了两种应激反应模式。“失败反应”主要涉及皮质醇轴，而“战斗-逃跑反应”由交感肾上腺系统介导。本横断面研究招募了从人群中随机选取的91名男性和88名年龄在20至70岁之间的女性。在上午8点测量诊室血压、血浆皮质醇和血浆NPY（均通过放射免疫分析法进行分析），并进行24小时动态血压（ABP）监测。WCE定义为仰卧位诊室血压减去日间平均ABP。在总体样本中*，皮质醇与收缩期WCE相关（r = 0.22，p = 0.005），在45至70岁的男性中相关（r = 0.45，p = 0.002，n = 47），在45至70岁的女性中*与舒张期WCE相关（r = 0.37，p = 0.02，n = 38）。（*排除接受雌激素治疗或怀孕的女性，n = 21）。仅在女性中，NPY与收缩期WCE呈弱相关（r = 0.22, p = 0.044）。有一个或多个一级高血压亲属的受试者比没有的受试者收缩期WCE更明显（分别为-0.02±10 mmHg和-4.1±9.3 mmHg，p = 0.01）。总之，皮质醇与WCE的相关性比NPY更强。这表明WCE是一种失败反应而非战斗-逃跑反应。
