Adverse Prognostic Value of Persistent Office Blood Pressure Elevation in White Coat Hypertension
Adverse Prognostic Value of Persistent Office Blood Pressure Elevation in White Coat Hypertension
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DOI：
10.1161/hypertensionaha.115.05367
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发表时间：
2015-08-01
期刊：
影响因子：
8.3
通讯作者：
Bombelli, Michele
中科院分区：
文献类型：
--
作者：
Mancia, Giuseppe;Facchetti, Rita;Bombelli, Michele
对白大衣高血压(WCH)患者进行心血管风险分层是至关重要的，以确定需要更密切的随访和抗高血压药物治疗的个体。在代表意大利蒙扎普通人群的受试者中，心血管疾病和全因死亡的风险被评估了16年，其中稳定和不稳定的WCH个体，即那些在连续两次就诊时动态血压(BP)正常与持续或非持续办公室血压升高相关的人。将数据与完全正常血压组的数据进行比较，即动态血压正常和持续的办公室血压正常。与正常血压组相比，不稳定的白血压病患者发生心血管死亡和全因死亡的风险没有显著差异，而在稳定的白血压病患者中，调整了包括动态血压在内的基线混杂因素后，风险也增加(心血管死亡的危险比为16；全因死亡的危险比为1.92；P=0.02)。在多变量分析中，办公室血压是独立预测死亡的因素之一，结果与使用蒙扎人群和指南得出的动态血压正常界值(分别为125/79和130/80毫米汞柱)是重叠的。因此，只有当办公室血压持续升高时，WCH才反映出异常长期死亡风险的存在。这意味着在WCH办公室，BP与预后相关，重复收集其值对于更好地定义患者风险具有重要的临床意义。
Stratification of cardiovascular risk is of fundamental importance in white coat hypertension (WCH) to identify individuals in need of closer follow-up and perhaps antihypertensive drug treatment. In subjects representative of the general population of Monza (Italy), the risk of cardiovascular and all-cause mortality was assessed >16 years in stable and unstable WCH individuals, that is, those in whom ambulatory blood pressure (BP) normality was associated with a persistent or nonpersistent office BP elevation at 2 consecutive visits, respectively. Data were compared with those from an entirely normotensive group, that is, ambulatory and persistent office BP normality. Compared with the normotensive group, the risk of cardiovascular and all-cause death was not significantly different in unstable WCH, whereas in stable WCH the risk was increased also when data were adjusted for baseline confounders, including ambulatory BP (hazard ratio, 16; P=0.001 for cardiovascular death and 1.92; P=0.02 for all-cause death). At a multivariable analysis, office BP was among the factors independently predicting death, and results were superimposable with use of Monza population-derived and guidelines-derived cutoff values for ambulatory BP normality (125/79 and 130/80 mm Hg, respectively). Thus, only when office BP is persistently elevated does WCH reflect the existence of an abnormal long-term mortality risk. This means that in WCH office BP is prognostically relevant and that repeated collection of its values is clinically important to better define patient risk.