The Value Of White Coat Effect In The Diagnosis And Treatment Of Patients With Essential Hypertension

Objects: To study the value of white coat effect in the diagnosis and treatment of patients with essential hypertension.Methods: 410 patients with grades 1-2 essential hypertension were recruited in outpatient of cardiovascular, including 104 untreated patients and 306 patients being treated with antihypertensive drugs for 3 months or more. Home blood pressure(HBP) were measured with a automatic oscillometric blood pressure measuring device for 1 week. HBP is the average of these readings, with exclusion of the first monitoring day. According to the differences of the office blood pressure(OBP) and their HBP, the untreated patients were defined as sustained hypertensive patients(n=66) and white coat hypertensive patients(n=38); the treated participants were classified into four types: controlled hypertension(n=131), treated normalized hypertension(n=95), masked effect hypertension(n=16), sustained uncontrolled hypertension(n=64). The prevalence of white coat hypertension and treated normalized hypertension were calculated. The statistical method of stepwise binary logistic regression were used to select the possible factor affecting white coat hypertension and treated normalized hypertension.Results: 1. In the untreated group, the prevalence of white coat hypertension was 36.54%(38/104). White coat hypertensive patients showed larger white coat effects compared with sustained hypertensive patients,(ΔSBP: 22.63 ± 9.73 VS 10.37 ± 8.66 mm Hg, p <0.05; ΔDBP: 15.02 ± 6.64 VS 6.58 ± 5.51 mm Hg, p <0.05). The incidence of morning hypertension was lower in white coat hypertension than that in sustained hypertension(21.05% VS 98.48%, p <0.05). After adjustment for gender and age logistic regression analysis showed that only office blood pressure grade(OR=0.109, 95%CI: 0.04~0.301, p<0.05) and WCE grade(OR=8.276, 95%CI: 4.157~16.475, p <0.05) were independently associated with white coat hypertension in patients with untreated high office blood pressure..2.In the treated group, the prevalence of treated normalized hypertension is 31.05%, whose white coat effects was the greatest compared with controlled hypertension and sustained uncontrolled hypertension,(ΔSBP: 25.17 ± 9.97 > 7.13 ± 9.92 and 8.09 ± 9.39 Vmm Hg, p <0.05). No significant difference was found in controlled hypertension and sustained uncontrolled hypertension. ΔDBP had similar tendency. The rate of morning blood pressure control was significantly higher in controlled hypertension and treated normalized hypertension than that in masked effect hypertension and sustained controlled hypertension,( 94.66% and 91.58% VS 0% and 4.69%, p <0.05). Logistic regression analysis showed that only office blood pressure grade(OR=0.109, 95%CI: 0.04~0.301, p<0.05), WCE grade(OR=8.276, 95%CI: 4.157~16.475, p <0.05) were independently associated with treated normalized hypertension in patients.Conclusion: In the untreated group, the prevalence of white coat hypertension is 36.54%; in the treated group, the rate of treated normalized hypertension is 31.05%. The factors associated with white coat hypertension and normalized hypertension were WCE grade and office blood pressure grade.