上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2018, Vol. 38 ›› Issue (11): 1370-.doi: 10.3969/j.issn.1674-8115.2018.11.018

• 论著·临床研究 • 上一篇    下一篇

动态血压监测诊断高血压白大衣现象与隐匿现象的标准探讨

胡哲 1，陈歆 1，常桂丽 1，李明春 1，陈静 1，初少莉 1，王继光 1, 2   

  1. 1.上海交通大学医学院附属瑞金医院北院高血压科，上海 201801；2.上海交通大学医学院附属瑞金医院高血压科，上海 200025
  • 出版日期:2018-11-28 发布日期:2018-12-15
  • 通讯作者: 陈歆，电子信箱：heartmedi@163.com。初少莉，电子信箱：shaolichu@163.com。为共同通信作者。
  • 作者简介:胡哲（1988—），女，主治医师，硕士；电子信箱： pisces880305@126.com。
  • 基金资助:
    上海市嘉定区卫生和计划生育委员会高血压重点专科项目（ JDYXZDZK-2）；上海申康医院发展中心临床科技创新项目（ SHDC12016232）；上海交通大学医学院附属瑞金医院北院研究基金（ 2016GL04，2017ZY11）

Discussion on using ambulatory blood pressure monitoring in the diagnostic criteria of white coat and masked hypertension

HU Zhe1, CHEN Xin1, CHANG Gui-li1, LI Ming-chun1, CHEN Jing1, CHU Shao-li1, WANG Ji-guang1, 2   

  1. 1. Department of Hypertension, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai 201801, China; 2. Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2018-11-28 Published:2018-12-15
  • Supported by:
    Key Specialty Project of Hypertension of Shanghai Jiading District Health and Family Planning Commission, JDYXZDZK-2; Clinical Science and Technology Innovation Project of Shanghai Hospital Development Center, SHDC12016232; Research Fund of Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, 2016GL04, 2017ZY11

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摘要： 目的 ·探讨动态血压监测（ ambulatory blood pressure monitoring，ABPM）诊断高血压白大衣现象与隐匿现象的不同方法。方法 ·选择未服药正常高值者 [收缩压 /舒张压为（ 130～ 139）（/ 85～ 89）mmHg（1 mmHg0.133 kPa），n46]、1～ 2级高血压受检者 [收缩压 /舒张压为（ 140～ 179）（/ 90～ 109）mmHg，n187]与接受降压治疗的高血压患者（ n41），共 274例；采集其临床特征与实验室数据，测量诊室血压，进行 ABPM，以诊室血压与日间动态血压差值 95%和 5%百分位数分别作为诊断高血压白大衣现象与隐匿现象的切点，并与经典诊断方法比较。结果 ·采用经典诊断方法，未治疗与已治疗诊室高血压患者之间白大衣现象患病率无统计学差异（ 11.2% vs 7.3%，P0.460）；未治疗 2级高血压患者白大衣现象患病率显著高于 1级高血压患者（ 20.0% vs 8.5%，P0.033），但白大衣高血压在该 2组未治疗高血压之间无显著差异（ 2.2% vs 7.0%，P0.230）；正常高值血压组隐匿性高血压患病率为 73.9%，已治疗高血压患者隐匿性未控制高血压患病率为 4.9%。若以所有受试者诊室血压与日间动态血压差值 95%百分位数（≥ 20.50/20.50 mmHg）和 5%百分位数（≤ -18.67/-6.00 mmHg）分别作为高血压白大衣现象与隐匿现象的诊断切点，治疗组与未治疗组之间白大衣现象患病率无显著性差异（ 12.2% vs 9.1%，P0.543）；但未治疗 2级高血压组高于 1级高血压组（ 24.4% vs 4.2%，P0.000）；隐匿现象患病率在血压正常高值组（ 15.2%）、未治疗（ 5.9%）与已治疗高血压组（ 12.2%）间差异无统计学意义（P>0.05）。结论 ·以诊室血压与日间动态血压差值 95%和 5%百分位数作为高血压白大衣现象与隐匿现象的一种诊断方法有其合理性，值得进一步探讨。

关键词: 诊室血压, 动态血压, 白大衣高血压, 隐匿性高血压

Abstract:

Objective · To investigate different methods on the diagnosis of white coat and masked phenomena in ambulatory blood pressure monitoring (ABPM). Methods · Information of clinical characteristics and laboratory data were collected, and measurements of office blood pressure (OBP) and ambulatory blood pressure (ABP) in 274 subjects were performed, including 46 persons with high normal OBP (SBP/DBP 130-139/85-89 mmHg) (1 mmHg0.133 kPa), 187 untreated patients with grade 1 and grade 2 hypertension (SBP/DBP 140-179/90-109 mmHg), and 41 treated hypertensive patients. Differences of 95th and 5th percentile between OBP and daytime ABP, were respectively taken as the cutoff for the definition of white coat phenomenon and masked phenomenon. Results · If white coat and masked phenomenon were diagnosed according to the current hypertension guidelines, the prevalence of white coat phenomenon did not differ between untreated and treated hypertensive patients (11.2% vs 7.3%, P0.460). In the untreated group, the prevalence of white coat phenomenon was higher in grade 2 than in grade 1 hypertension (20.0% vs 8.5%, P0.033), whereas the prevalence of white coat hypertension did not differ (2.2% vs 7.0%, P0.230). The prevalence of masked hypertension was 73.9% in high normal blood pressure group. The prevalence of masked uncontrolled hypertension was 4.9%. If the difference of 95th percentile ( ≥20.50/20.50 mmHg) and 5th percentile (≤-18.67/-6.00 mmHg) between OBP and daytime ABP were, respectively, used as the cutoff for the definition of white coat and masked phenomenon, the prevalence of white coat phenomenon did not differ between treated and untreated groups (12.2% vs 9.1%，P0.543). In the untreated group, the prevalence of white coat phenomenon was higher in grade 2 than in grade 1 hypertension (24.4% vs 4.2%, P0.000). The prevalence of masked phenomenon did not differ between persons with high normal OBP (15.2%) and untreated (5.9%) as well as treated hypertensive patients (12.2%) (P>0.05). Conclusion · The percentile methods may be useful for the diagnosis of white coat and masked phenomena.

Key words: office blood pressure, ambulatory blood pressure, white coat hypertension, masked hypertension

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