Περίληψη:
Background: Some studies have shown a significant white coat effect
(WCE) (i.e., difference between clinic blood pressure [CBP] and awake
ambulatory blood pressure [ABP]) to be present not only in untreated
but also in treated hypertensive individuals. This study aims to assess
1) the prevalence and the magnitude of the WCE in treated versus
untreated hypertensive persons, and 2) the usefulness of home blood
pressure (HBP) versus ABP in the detection of this phenomenon.
Methods: A case-control study was conducted in 138 treated hypertensive
patients and same number of sex- and age-matched untreated hypertensive
subjects who had measurements of CBP (at least three visits), HBP, and
ABP. Subjects with a WCE of >20/10 turn Hg (systolic/ diastolic) were
classified as clinic reactors.
Results: There was a trend for a larger WCE assessed by ABP monitoring
in the untreated group (mean difference in systolic WCE, 1.8+/-22.2 mm
Hg, 95% CI -2.0 to 5.5; diastolic 1.8+/-11.9 mm Mg, 95% CI -0.2 to
3.8) and for more untreated clinic reactors (27% untreated v 20%
treated, odds ratio 1.5, 95% CI 0.9 to 2.7). The sensitivity,
specificity, and positive and negative predictive values of HBP to
detect clinic reactors correctly were 56%/62% (treated/untreated),
87%/84%, 52%/59%, and 89%/86%, respectively, with moderate
agreement between HBP and ABP (kappa 0.42/0.46).
Conclusions: In treated hypertensive patients, WCE seems to be reduced
compared with that in untreated hypertensive persons but is not
eliminated. In both untreated and treated hypertensive individuals HBP
monitoring appears to be useful in the detection of the WCE, but it may
not be appropriate as an alternative to the ABP method. (C) 2004
American Journal of Hypertension, Ltd.
Συγγραφείς:
Stergiou, GS
Efstathiou, SP
Argyraki, CK
Roussias, LG and
Mountokalakis, TD
