Carmona J, Amado P, Vasconcelos N, Santos I, Pinto C, Forte G, Arsénio A, Nazaré J
Serviço de Cardiologia, Hospital Egas Moniz, Lisboa.
Rev Port Cardiol. 1998 Jun;17(6):505-12.
Previous studies have demonstrated a high prevalence of "white coat" hypertension (20%), but it is still controversial if it implies an increase in cardiovascular risk.
Between 1992 and 95 we prospectively studied 175 untreated hypertensive patients aged over 18 years (V Joint National Committee's stage I-II), and 91 controls.
The subjects were submitted to clinical evaluation, ambulatory blood pressure monitoring, 24-hour Holter monitoring, signal-averaged ECG, echocardiography/Doppler and ergometry. "White coat" hypertension was defined as mean daytime (6.00-22.00 H) ambulatory blood pressure < 136/87 mm Hg (males) and < 131/86 mm Hg (females).
"White coat" hypertension was present in 29 patients (18%). "White coat" hypertension patients had an identical prevalence of smoking, family history of cardiovascular disease, abnormal ECG and retinopathy (> Keith-Wagener II) as patients with daytime hypertension. Ambulatory blood pressure values (24 hour, 6.00-22.00 h, 22.00-6.00 h, sleep, blood pressure load, heart rate) were all significantly different from controls (p < 0.03 to 0.0007). In patients with daytime hypertension, only 24 hour and daytime diastolic ambulatory blood pressure (p < 0.005) were different from "white coat" hypertension patients. Exercise testing blood pressure values (6 min exercise, maximal, 3 min recovery) were significantly different between "white coat" hypertension patients and the control group (n = 70) (p varying from 0.05 to 0.005) but not between "white coat" hypertension and daytime hypertension (n = 33) patients. Diastolic function was studied only in 39 daytime hypertension patients, 10 individuals with "white coat" hypertension and 34 controls (for technical reasons and because we only analyzed individuals younger than 55 years). E velocity and E/A ratio were similar in "white coat" hypertension and daytime hypertension, but only in daytime hypertension patients they reached a significant difference from controls (p = 0.04; p = 0.01), probably due to the small number of patients.
These data (clinical, ambulatory blood pressure, ergometric, diastolic function) suggest that "white coat" hypertension might not be a benign entity.
既往研究已证实“白大衣”高血压的患病率较高（20%），但其是否意味着心血管风险增加仍存在争议。
1992年至1995年间，我们前瞻性研究了175例年龄超过18岁的未经治疗的高血压患者（美国联合国家委员会I-II期）以及91例对照者。
对受试者进行临床评估、动态血压监测、24小时动态心电图监测、信号平均心电图、超声心动图/多普勒检查及运动试验。“白大衣”高血压定义为日间平均（6:00 - 22:00）动态血压<136/87 mmHg（男性）和<131/86 mmHg（女性）。
29例患者（18%）存在“白大衣”高血压。“白大衣”高血压患者在吸烟、心血管疾病家族史、心电图异常及视网膜病变（>Keith-Wagener II级）方面的患病率与日间高血压患者相同。动态血压值（24小时、6:00 - 22:00、22:00 - 6:00、睡眠、血压负荷、心率）均与对照组有显著差异（p<0.03至0.0007）。在日间高血压患者中，仅24小时及日间舒张压动态血压（p<0.005）与“白大衣”高血压患者不同。运动试验血压值（6分钟运动、最大运动、3分钟恢复）在“白大衣”高血压患者与对照组（n = 70）之间有显著差异（p值从0.05至0.005），但在“白大衣”高血压与日间高血压（n = 33）患者之间无差异。仅对39例日间高血压患者、10例“白大衣”高血压患者及34例对照者（因技术原因且仅分析年龄小于55岁的个体）进行了舒张功能研究。“白大衣”高血压和日间高血压患者的E波速度及E/A比值相似，但仅日间高血压患者与对照组有显著差异（p = 0.04；p = 0.01），可能是由于患者数量较少。
这些数据（临床、动态血压、运动试验、舒张功能）提示“白大衣”高血压可能并非良性情况。
