Cardiovascular Risk Associated With White-Coat Hypertension Pro Side of the Argument
Cardiovascular Risk Associated With White-Coat Hypertension Pro Side of the Argument
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DOI：
10.1161/hypertensionaha.117.08903
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发表时间：
2017-10-01
期刊：
影响因子：
8.3
通讯作者：
Grassi, Guido
中科院分区：
文献类型：
--
作者：
Mancia, Giuseppe;Bombelli, Michele;Grassi, Guido
本文将支持以下观点：白大衣高血压 (WCH)，即办公室升高与正常动态血压或家庭血压 (BP) 之间的关联，1 不是一种无害疾病，而是一种与心血管风险增加相关的疾病。这将基于以下证据：与正常血压对照相比，WCH 受试者 (1) 代谢危险因素和无症状器官损伤的患病率增加；(2) 更频繁地进展为高心血管风险状态，如持续性高血压、糖尿病和左心室肥厚； (3) 从中长期来看，心血管疾病和致命事件的风险更大。然而，还要提到的是，WCH 的重要临床和机制方面仍未完全阐明：诊室血压与诊室外血压对风险增加的贡献；生物标志物可以在 WCH 人群中区分风险较高的受试者和正常风险的受试者；以及抗高血压药物的使用对患者预后的影响。澄清这些方面是医学研究的首要任务，因为WCH在所有高血压级别中都很常见，当诊室血压轻度升高时，其患病率占高血压人群的三分之一以上。 2
This article will support the view that white-coat hypertension (WCH), that is, the association of an elevated office with a normal ambulatory or home blood pressure (BP), 1 is not an innocent condition but a condition associated with an increased cardiovascular risk. This will be based on the evidence that compared with normotensive controls, subjects with WCH (1) have an increased prevalence of metabolic risk factors and asymptomatic organ damage;(2) more frequently progress to high cardiovascular risk states such as sustained hypertension, diabetes mellitus, and left ventricular hypertrophy; and (3) exhibit, over the mid and long term, a greater risk of cardiovascular morbid and fatal events. It will also be mentioned, however, that important clinical and mechanistic aspects of WCH remain incompletely clarified: the contribution of office versus out-of-office BP to the increased risk; the biomarkers that may allow to distinguish, within the WCH population, subjects at greater versus those at normal risk; and the effect of antihypertensive drug administration on patients’ prognosis. Clarification of these aspects represents a priority for medical research because WCH is common in all hypertension grades, its prevalence accounting for more than one third of the hypertensive population when the office BP elevation is mild. 2