Diagnosis of mild hypertension by ambulatory blood pressure monitoring.
Diagnosis of mild hypertension by ambulatory blood pressure monitoring.
复制标题
通过动态血压监测诊断轻度高血压。
DOI：
10.1161/01.cir.90.5.2291
复制
发表时间：
1994
期刊：
影响因子：
37.8
通讯作者：
W. Graettinger
中科院分区：
文献类型：
--
作者：
MICHAEL A. Weber;J. Neutel;David H.G. Smith;W. Graettinger
背景
在临床诊断为高血压的患者中，20%至30%的患者在24小时自动动态血压监测中血压(BP)值正常。然而，目前还不清楚这些患者是否可以被视为血压正常，或者他们是否应该像确诊的高血压患者一样得到同样的治疗。
方法和结果
对88例正常对照组和171例高血压病患者(办公室舒张压和舒张压)进行动态血压监测(3次就诊时血压为90 mm Hg，从未治疗或停药6个月以上)。如果高血压患者的24小时平均舒张压低于正常值85毫米汞和至少15毫米汞，则将其归类为未确诊或白大衣患者(n=58)。为了进行比较，白大衣患者与正常受试者在24小时平均舒张期和性别，以及相似的年龄和体重上进行配对；有40对这样的配对。白大衣患者与确诊的高血压患者通过相同的办公室BP(51对)进行配对。受试者通过个体化跑步机测试、多普勒超声心动图和静息血浆儿茶酚胺、直立血浆肾素和醛固酮以及血脂、血糖和胰岛素浓度的测定进行研究。由于匹配，与正常受试者相比，白大衣高血压患者和正常受试者具有相同的24小时血压平均值。白大褂患者在全天的个体读数(每15分钟获得一次)中表现出稍大的变异性[P<；0.05]，但对运动的血流动力学反应没有差异。白大衣组血浆去甲肾上腺素(P<；0.05)、肾素和醛固酮(P<；0.01)、胰岛素和低密度脂蛋白胆固醇(P<；01)水平较高，左室隔壁(P<；0.05)和肌肉质量(P=0.07)超声心动图测量结果也较高。与确诊的高血压患者相比，白大衣患者的肾素水平较高(P<；.01)，但其他方面相似。在白大衣组中，血浆去甲肾上腺素与总胆固醇和甘油三酯相关(P<；0.05)，而醛固酮与左心室重量相关(P<；0.01)；在正常对照组或确诊高血压组中没有显著相关性。
结论
白大衣高血压患者的代谢、神经内分泌和心脏表现与正常对照组不同，并且具有更大的血压变异性。这些变化似乎是通过交感神经和肾素-血管紧张素系统的高活性来调节的。尽管这些特征可能反映了临床上由于意识到自己的诊断而产生的警觉反应，但白大衣高血压患者也有证据表明，他们与正常受试者有更多、更持久的差异。因此，这种情况似乎是高血压的真正变种。
BACKGROUND
Between 20% and 30% of patients with clinically diagnosed hypertension have normal blood pressure (BP) values during automated ambulatory 24-hour BP monitoring. It has not been clear, however, whether these patients can be regarded as normotensive or whether they should be treated in the same way as confirmed hypertensive patients.
METHODS AND RESULTS
Ambulatory BP monitoring was performed in 88 normal control subjects and 171 hypertensive patients (office diastolic BP > or = 90 mm Hg on three visits; never treated or off treatment for more than 6 months). Hypertensive patients were classified as nonconfirmed or white coat (n = 58) if their 24-hour diastolic averages were < 85 mm Hg and at least 15 mm Hg lower than their office values. For comparisons, white coat patients were pair-matched with normal subjects by 24-hour diastolic averages and sex, and by similar age and weight; there were 40 such pairs. White coat patients were likewise pair-matched with confirmed hypertensive patients by identical office BPs (51 pairs). Participants were studied by individualized treadmill testing, Doppler echocardiography, and assays of resting plasma catecholamines, upright plasma renin and aldosterone, and lipid, glucose, and insulin concentrations. Because of the matching, compared with normal subjects, patients with white coat hypertension and normal subjects had identical 24-hour BP averages. The white coat patients exhibited slightly greater variability among individual readings (obtained each 15 minutes) throughout the day [P < .05]), but there were no differences in hemodynamic responses to exercise. Plasma norepinephrine (P < .05), renin and aldosterone (P < .01 for each), and insulin and low-density lipoprotein cholesterol levels (P < .01 for each) were higher in the white coat group, as were left ventricular septal wall (P < .05) and muscle mass (P = .07) echocardiographic measurements. When compared with the confirmed hypertensive patients, the white coat patients had higher renin (P < .01) but were otherwise similar. Within the white coat group, plasma norepinephrine correlated with total cholesterol and triglycerides (P < .05 for each), and aldosterone correlated with left ventricular mass (P < .01); there were no significant correlations within the normal control subject or confirmed hypertension groups.
CONCLUSIONS
Patients with white coat hypertension differ in metabolic, neuroendocrine, and cardiac findings from normal control subjects and have greater BP variability. These changes appear to be mediated by heightened activity of the sympathetic and renin-angiotensin systems. Although these characteristics could reflect an alerting reaction in the clinic due to awareness of their diagnosis, the white coat hypertensive patients also have evidence for additional, more-sustained differences from normal subjects. Thus, this condition appears to be a true variant of hypertension.
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DOI：
10.1001/jama.1988.03720020027031
发表时间：
1988-01
期刊：
JAMA
影响因子：
--
作者：
T. Pickering;G. James;Charlene Boddie;G. Harshfield;S. Blank;J. Laragh
通讯作者：
T. Pickering;G. James;Charlene Boddie;G. Harshfield;S. Blank;J. Laragh
DOI：
10.1001/jama.1990.03450030078036
发表时间：
1990-07
期刊：
JAMA
影响因子：
--
作者：
S. Julius;K. Jamerson;A. Mejia;L. Krause;N. Schork;Kerin Jones
通讯作者：
S. Julius;K. Jamerson;A. Mejia;L. Krause;N. Schork;Kerin Jones
影响因子：
37.8
作者：
DEVEREUX, RB;PICKERING, TG;LARAGH, JH
通讯作者：
LARAGH, JH
边缘性高血压男性的动态血压变化与血浆肾素活性有关。
影响因子：
3.2
作者：
James,GD;Pickering,TG;Laragh,JH
通讯作者：
Laragh,JH