The white coat phenomenon is benign in referred treated patients: a 14-year ambulatory blood pressure mortality study
The white coat phenomenon is benign in referred treated patients: a 14-year ambulatory blood pressure mortality study
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DOI：
10.1097/hjh.0b013e3282f4b3bf
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发表时间：
2008-04-01
影响因子：
4.9
通讯作者：
Bursztyn, Michael
中科院分区：
文献类型：
--
作者：
Ben-Dov, Iddo Z.;Kark, Jeremy D.;Bursztyn, Michael
目的以往关于白色被毛高血压预后的报道不明确。我们的目的是确定治疗patients.Methods我们的14年的医院为基础的动态血压（BP）监测前瞻性数据库的全因死亡率的白色大衣现象的预后影响进行了分析。白色外套和掩蔽效应与死亡率的关系进行了评估，分类（控制清醒与诊所BP）和连续模式（临床清醒BP差异）。结果在随访期间，2285例治疗患者（年龄61 +/- 13岁，57%女性）进行了监测（17 621例患者年，286例死亡）。平均BMI为27.8 +/- 4.5 kg/m2，13%接受糖尿病治疗。控制性高血压（正常门诊血压和清醒血压）占15.8%，高门诊血压（控制性清醒血压，即白色大衣未控制的高血压）占12.1%，清醒高血压（控制性门诊血压，即掩盖的未控制的高血压）占11.8%，持续性高血压（门诊血压和清醒血压）占60.3%。与白色被毛者相比，年龄校正的Cox比例全因死亡风险比，控制性高血压为1.42（0.81-2.51），未控制性高血压为1.88（1.08 - 3.27），持续性高血压为2.02（1.30 - 3.13）。门诊-清醒BP差异每增加1%的风险比为0.992（0.983 - 1.002）收缩压和0.981（0.971 - 0.991），分别校正年龄、性别、糖尿病、清醒时收缩压或舒张压。结论在接受动态血压监测的高血压患者中，白色被膜效应与预后较差的反向（掩蔽）现象相比是良性的。
Objective Previous reports on the prognosis of white coat hypertension are ambiguous. We aimed to determine the prognostic implications of the white coat phenomenon in treated patients.Methods Our 14-year hospital-based ambulatory blood pressure ( BP) monitoring prospective database was analyzed for all-cause mortality. The relationships of the white coat and masking effects with mortality were assessed both categorically ( controlled awake versus clinic BP) and in a continuous mode (clinic-awake BP difference).Results During the follow-up period, 2285 treated patients ( aged 61 +/- 13 years, 57% women) were monitored ( 17 621 patient-years, 286 deaths). Mean BMI was 27.8 +/- 4.5 kg/m(2) and 13% were treated for diabetes. Controlled hypertension ( normal clinic and awake BP) was found in 15.8%, high clinic BP ( with controlled awake BP; namely, white coat uncontrolled hypertension) in 12.1%, awake hypertension ( with controlled clinic BP; namely, masked uncontrolled hypertension) in 11.8%, and sustained hypertension ( both clinic and awake) in 60.3%. Compared with white coat uncontrolled hypertension, age-adjusted Cox-proportional all-cause mortality hazard ratios were 1.42 (0.81-2.51) for controlled hypertension, 1.88 (1.08 - 3.27) for masked uncontrolled hypertension, and 2.02 (1.30 - 3.13) for sustained hypertension. Hazards ratios per 1% increase in the clinic - awake BP difference were 0.992 (0.983 - 1.002) for systolic BP and 0.981 (0.971 - 0.991) for diastolic BP, adjusted for age, sex, diabetes, and either systolic or diastolic awake BP, respectively.Conclusion In treated hypertensive patients referred for ambulatory BP monitoring, the white coat effect is benign compared with the reverse (masking) phenomenon, which has a poorer prognosis.