Stergiou G S, Zourbaki A S, Skeva I I, Mountokalakis T D
Hypertension Centre, Third University Department of Medicine, Sotiria Hospital, Athens, Greece.
Am J Hypertens. 1998 Jul;11(7):820-7. doi: 10.1016/s0895-7061(98)00038-7.
The objective of the study was to investigate whether home blood pressure (HBP) is a reliable alternative to ambulatory blood pressure (ABP) for the detection of the white coat effect (WCE). Hypertensive patients were randomized to measure HBP for 2 weeks or ABP for 24 h. The alternative measurement was then performed. Clinic blood pressure (CBP) was measured in the beginning and end of the study. Subjects with a difference of > or = 20 mm Hg systolic or > or = 10 mm Hg diastolic BP between CBP and awake ABP or CBP and HBP, were classified as clinic reactors. A total of 189 patients completed the study (79 on stable antihypertensive treatment). There was no difference in the magnitude of WCE assessed using the ABP or the HBP method (mean discrepancy, systolic BP: -1.5 +/- 11.7 mm Hg, 95% CI -3.2, 0.2; diastolic BP: 0.9 +/- 7.0, 95% CI -0.1, 1.9). A strong association existed between WCE calculated using the HBP or the ABP method (r = 0.64/0.59 systolic/diastolic, P < .001). The proportion of patients classified as clinic reactors was identical using the HBP or the ABP method (25.9%). Agreement between methods in the classification of clinic reactors was found in 147 patients (78%). The sensitivity and specificity of the HBP method to classify correctly clinic reactors (ABP method used as the standard) were 57% and 85%, respectively, whereas its positive and negative predictive value were 57% and 85%. These results indicate that HBP is not appropriate as an alternative to ABP diagnostic testing in the detection of WCE. Nevertheless, HBP appears useful as a screening test for the detection of this phenomenon.
本研究的目的是调查家庭血压（HBP）在检测白大衣效应（WCE）方面是否可作为动态血压（ABP）的可靠替代方法。将高血压患者随机分为两组，一组测量2周的家庭血压，另一组测量24小时的动态血压。然后进行替代测量。在研究开始和结束时测量诊室血压（CBP）。收缩压差值≥20 mmHg或舒张压差值≥10 mmHg的CBP与清醒时ABP或CBP与HBP之间的受试者被归类为诊室反应者。共有189名患者完成了研究（79名接受稳定的降压治疗）。使用ABP或HBP方法评估的WCE大小没有差异（平均差异，收缩压：-1.5±11.7 mmHg，95%可信区间-3.2，0.2；舒张压：0.9±7.0，95%可信区间-0.1，1.9）。使用HBP或ABP方法计算的WCE之间存在很强的相关性（收缩压/舒张压的r = 0.64/0.59，P <.001）。使用HBP或ABP方法归类为诊室反应者的患者比例相同（25.9%）。在147名患者（78%）中发现了两种方法在诊室反应者分类上的一致性。HBP方法正确分类诊室反应者（以ABP方法为标准）的敏感性和特异性分别为57%和85%，而其阳性和阴性预测值分别为57%和85%。这些结果表明，在检测WCE方面，HBP不适宜作为ABP诊断测试的替代方法。然而，HBP似乎作为检测这种现象的筛查测试是有用的。
