原发性高血压患者中的白大衣效应及其与血压变异性的相关性

Relationship between white coat effect and blood pressure variability in essential hypertension

目的探讨原发性高血压患者中的白大衣效应的发生率及其与血压变异性的相关性。方法1级、2级原发性高血压患者410例自愿参加本研究。受试者自测1周家庭血压,根据诊室血压与家庭血压情况进行分类:未治疗患者分为白大衣性高血压(n=38)和持续性高血压(n=66);已治疗患者分为已控制高血压(n=131)、白大衣未控制高血压(n=95)、隐蔽性未控制高血压(n=16)、持续未控制高血压(n=64);并对治疗患者中既往高血压基于诊室内外血压联合诊断的患者进行亚组分析。结果(1)白大衣性高血压和白大衣未控制高血压发生率分别为36.5%(95%CI27.2%~45.8%)和31.0%(95%CI25.8%~36.2%);既往高血压基于诊室内外血压联合诊断的亚组中,白大衣未控制高血压发生率仅为21.7%(95%CI 14.5%~28.9%),低于单纯以诊室血压为诊断依据的患者(34.5%)。(2)白大衣性高血压患者白大衣效应程度(诊室血压-家庭血压)高于持续性高血压患者[Δ收缩压/Δ舒张压:(22.6±9.7)/(15.0±6.6)比(10.4±8.7)/(6.6±5.5)mm Hg,t=6.64和6.97,均P<0.05]。白大衣未控制高血压患者白大衣效应的程度高于已控制及未控制高血压患者[Δ收缩压/Δ舒张压:(25.2±9.9)/(10.7±7.2)比(7.1±9.9)/(4.5±7.3)和(8.1±9.4)/(6.1±8.2)mm Hg,F=105.4和19.39,均P<0.05]。(3)白大衣性高血压/白大衣未控制高血压患者家庭自测收缩压变异性较持续性高血压/持续未控制高血压患者有降低趋势。结论在1级、2级高血压患者中白大衣性高血压/白大衣未控制高血压发生率高,但是在既往高血压基于诊室内外血压联合诊断的亚组中白大衣未控制高血压发生率较低。白大衣性高血压/白大衣未控制高血压患者白大衣效应程度大、血压变异性有降低趋势。

Objective To investigate the incidence of white coat effect(WCE)and to analyze the relationship between WCE and blood pressure variability in essential hypertension(EH).Methods A total of 410 patients with grade 1 and grade 2 EH voluntarily participated in this study.Blood pressure was self-measured at home for one week.Based on home blood pressure(HBP)and office blood pressure(OBP),the subjects untreated were divided into white coat hypertension(WCH,n=38)and sustained hypertension(SHT,n=66);and the treated subjects were grouped into sustained controlled hypertension(SCH,n=131),white-coat uncontrolled hypertension(WCUH,n=95),masked uncontrolled hypertension(MUCH,n=16),and sustained uncontrolled hypertension(SUCH,n=64).And the subgroup analysis was performed in the treatment hypertensives whose diagnosis based on blood pressures inside and outside the clinic.Results(1)WCH and WCUH patients accounted for 36.5%(95%CI 27.2%-45.8%)and 31.0%(95%CI 25.8%-36.2%)respectively in this population while only acconted for 21.7%(95%CI 14.5%-28.9%)in hypertensives whose diagnosis based on OBP and out-of-office blood pressure(BP),which was significantly lower than that based on OBP alone(34.5%).(2)The WCE,that was,the difference between OBP and HBP,in the WCH patients was significantly stronger than SHT patients[Δsystolic blood pressure/Δdiastolic blood pressure:(22.6±9.7)/(15.0±6.6)vs(10.4±8.7)/(6.6±5.5)mm Hg,t=6.64 and 6.97,both P<0.05],and stronger in the WUCH group compared to SCH and SUCH groups[Δsystolic blood pressure/Δdiastolic blood pressure:(25.2±9.9)/(10.7±7.2)vs(7.1±9.9)/(4.5±7.3)and(8.1±9.4)/(6.1±8.2)mm Hg,F=105.4 and 19.39,both P<0.05].(3)Home systolic blood pressure variability(HSBPV)exhibited decreasing trends in the WCH and WUCH patients compared with SHT and SUCH patients.Conclusions The incidences of WCH and WUCH are high in grade 1 and grade 2 hypertensive patients.However,the incidence of WUCH decreases in treated patients diagnosed with OBP and out-of-office BP.Relative to other patients,WCH and WUCH patients experience stronger WCE and exhibit a decreasing trend of blood pressure variability.