摘要
目的:调查接受与未接受治疗的高血压患者在多次血压测量时白大衣效应(WCE)和白大衣高血压(WCH)的发生率与持续性。设计:在1年时间内,8次就诊(每次就诊共读数3次)均接受诊室血压测量(OBPM)的原发性高血压患者,在每次就诊前自测血压(SBPM)1周(每周42次读数)。
OBJECTIVE:To investigate the prevalence and persistence of the white-coat effect(WCE) and white-coat hypertension(WCH) on multiple blood pressure measurement occasions in hypertensive patients with and without treatment. DESIGN:Essential hypertensive patients in whom we took office blood pressure measurements(OBPM) at eight visits(three readings per visit) performed self blood pressure measurements(SBPM)for 1 week prior to each visit(42 readings per week) over a period of 1 year. All measurements were performed with the same automatic device(Omron 705CP). In addition,24-h ambulatory blood pressure monitoring(ABPM) was performed at the start and at the end of the study. At the start,patients did not use any medication but on subsequent visits they were treated on the basis of their SBPM values. WCH was defined as an OBPM-value ≥140 and/or 90 mmHg and a SBPM or daytime ABPM value<135/85 mmHg. This definition was used irrespective of treatment. We also determined the prevalence of a substantial WCE(OBPM 20 mmHg systolic or 10 mmHg diastolic higher than SBPM or daytime ABPM). SETTING:Patients were recruited at hospital or general practice. PATIENTS:A total of 163 mild-to-moderate essential hypertensive patients with a mean age of 56 years(56%males). RESULTS:At eight blood pressure(BP) measurement occasions,75%of all patients had a substantial WCE at least once,while 57%had WCH at least once. One-third of the patients consistently had a substantial WCE and 14%consistently had WCH on three or more occasions. The magnitude of the WCE was significantly related to the height of blood pressure in treated but not in untreated patients. CONCLUSION:In some patients,WCH or a substantial WCE occurs consistently on multiple OBPM visits. Especially in untreated patients,the magnitude of the WCE varies widely among individuals. These results support the incorporation of SBPM and/or ABPM into optimal management of hypertension,not only to prevent misdiagnosis in untreated patients but also to determine the need for adjusting antihypertensive therapy in treated subjects.
