Høegholm A, Kristensen K S, Bang L E, Nielsen J W
Department of Internal Medicine, County Central Hospital, Naestved, Denmark.
J Hum Hypertens. 1998 Jul;12(7):433-9. doi: 10.1038/sj.jhh.1000654.
The aim of this cross-sectional study which took place in a hypertension clinic at a district general hospital in Denmark was to make a pragmatic definition of white coat hypertension. A total of 420 patients were referred consecutively from general practice with newly diagnosed untreated essential hypertension and 146 normal subjects were drawn at random from the Danish national register. The following measurements were taken: office blood pressure; 24-h ambulatory blood pressure (BP) monitoring; echocardiography with determination of left ventricular mass index and relative wall thickness; and early morning urine albumin/creatinine ratios. Four different cut-off levels were studied. An ambulatory daytime BP of 135.6/90.4 mm Hg was found to correspond to an office BP of 140/90 mm Hg in normal controls; used as a cut-off level in patients with newly diagnosed hypertension it separated 19% as white coat hypertensives. The end-organ involvement of these white coat hypertensives differed significantly from those with established hypertension but not from the normal controls. Lower cut-off levels were less efficient in this respect, as was the case when the systolic BP was not taken into account. In conclusion a pragmatic definition of white coat hypertension should--apart from well-established hypertensive office measurements--include a cut-off level close to 135/90 mm Hg ambulatory daytime BP.
这项横断面研究在丹麦一家地区综合医院的高血压诊所开展，旨在对白大衣高血压作出实用的定义。共有420例新诊断的未经治疗的原发性高血压患者从全科医疗连续转诊而来，另外从丹麦国家登记处随机抽取了146名正常受试者。进行了以下测量：诊室血压；24小时动态血压监测；超声心动图测定左心室质量指数和相对壁厚度；以及清晨尿白蛋白/肌酐比值。研究了四个不同的临界值水平。在正常对照中，发现动态日间血压135.6/90.4毫米汞柱相当于诊室血压140/90毫米汞柱；在新诊断的高血压患者中用作临界值水平时，可将19%的患者甄别为白大衣高血压患者。这些白大衣高血压患者的靶器官损害与确诊高血压患者有显著差异，但与正常对照无差异。在这方面，较低的临界值水平效率较低，不考虑收缩压时也是如此。总之，白大衣高血压的实用定义除了已确立的高血压诊室测量外，还应包括接近动态日间血压135/90毫米汞柱的临界值水平。
