动态血压监测中第一小时白大衣现象研究

The white coat effect during the first hour of ambulatory blood pressure

目的探讨动态血压监测中存在的第1小时白大衣现象及其影响。方法选择2004—2005年门诊和病房住院的患者共626例(其中男性369例,女性257例)年龄范围13～90岁,平均年龄为(55.0±13.7)岁。所有观察对象测量诊室血压,在上午8:30—9:29之间开始监测24小时动态血压,将此期间检测的3次血压平均值作为第1小时血压。结果所有观察对象第1小时的平均收缩压和舒张压显著高于23 h、白天、夜间和最后1 H 的平均水平(P<0.01),在不同年龄、性别组人群中也同样存在此种现象。女性中自大衣现象显著高于男性[第1小时平均血压-白天平均血压:女性:(9.5±13.4/6.0±7.8)mm Hg(1 mm Hg=0.133 kPa);男性:(5.5±11.9/4.2±7.8)mm Hg,P<0.01],而各年龄组间差异无统计学意义。结论动态血压监测中,普遍存在着明显的第1小时内血压升高的现象,建议在临床上判断血压水平和诊断中,删除第1小时的记录数据,以便更加准确客观地反映患者的真实血压水平,在临床药物疗效观察评价及科学研究中尤其重要。

Objectives To investigate the white coat effect during the first hour of ambulatory blood pressure and its effect on the ABPM. Methods A total of 626 outpatients and inpatients （257 were male, 369 were female） ,whose ages ranged from 13 to 90（ average age： 55 years） were entered into this study. All subjects were taken measurements of clinic blood pressure. Ambulatory BP monitoring was applied to the nondominant arm between 8：30 to 9：29, and set the average BP value of this interval as the first hour blood pressure. Results There was an obvious elevation of the first hour measurement than that of the other intervals of 24ABPM. The white coat effect （WCE） was greater in women than in men （average BP of 1^st hour-average BP in daytime ： （ 9. 5 ± 13.4 ）/（ 6.0 ± 7. 8 ） mm Hg （ 1 mm Hg = 0. 133 kPa ） vs. （ 5. 5 ± 11.9 ）/（4. 2 ± 7. 8 ）mm Hg, P 〈 0. 01 ）, and there was no statistic significant difference was founded among different age groups. Conclusion The first hour of ambulatory blood pressure monitoring is associated with significantly elevated blood pressure. We propose that improved ambulatory blood pressure monitoring recordings would be obtained in clinical practice, and more particularly in research applications, if 25 hours ambulatory blood pressure monitoring was carried out, excluding the first hour from the summary analyses.