The advent of ambulatory blood pressure monitoring permitted examination of blood pressures during sleep and recognition of the associated circadian fall in pressure during this period. The fall in pressure,called the...The advent of ambulatory blood pressure monitoring permitted examination of blood pressures during sleep and recognition of the associated circadian fall in pressure during this period. The fall in pressure,called the "dip",is defined as the difference between daytime mean systolic pressure and nighttime mean systolic pressure expressed as a percentage of the day value. Ten percent to 20% is considered normal. Dips less than 10%,referred to as blunted or absent,have been considered as predicting an adverse cardiovascular event. This view and the broader concept that white coat hypertension itself is a forerunner of essential hypertension is disputable. This editorial questions whether mean arterial pressures over many hours accurately represent the systolic load,whether nighttime dipping varies from measure to measure or is a fixed phenomenon,whether the abrupt morning pressure rise is a risk factor or whether none of these issues are as important as the actual night time systolic blood pressure itself. The paper discusses the difference between medicated and nonmedicated white coat hypertensives in regard to the cardiovascular risk and suggests that further work is necessary to consider whether the quality and duration of sleep are important factors.展开更多
There is arguably no less understood or more intriguing problem in hypertension that the"white coat"condition,the standard concept of which is significantly blood pressure reading obtained by medical personn...There is arguably no less understood or more intriguing problem in hypertension that the"white coat"condition,the standard concept of which is significantly blood pressure reading obtained by medical personnel of authoritative standing than that obtained by more junior and less authoritative personnel and by the patients themselves.Using hospital-initiated ambulatory blood pressure monitoring,the while effect manifests as initial and ending pressure elevations,and,in treated patients,a low daytime profile.The effect is essentially systolic.Pure diastolic white coat hypertension appears to be exceedingly rare.On the basis of the studies,we believe that the white coat phenomenon is a common,periodic,neuro-endocrine reflex conditioned by anticipation of having the blood pressure taken and the fear of what this measurement may indicate concerning future illness.It does not change with time,or with prolonged association with the physician,particularly with advancing years,it may be superimposed upon essential hypertension,and in patients receiving hypertensive medication,blunting of the nighttime dip,which occurs in about half the patients,may be a compensatory mechanisms,rather than an indication of cardiovascular risk.Rather than the blunted dip,the morning surge or the widened pulse pressure,cardiovascular risk appears to be related to elevation of the average night time pressure.展开更多
文摘The advent of ambulatory blood pressure monitoring permitted examination of blood pressures during sleep and recognition of the associated circadian fall in pressure during this period. The fall in pressure,called the "dip",is defined as the difference between daytime mean systolic pressure and nighttime mean systolic pressure expressed as a percentage of the day value. Ten percent to 20% is considered normal. Dips less than 10%,referred to as blunted or absent,have been considered as predicting an adverse cardiovascular event. This view and the broader concept that white coat hypertension itself is a forerunner of essential hypertension is disputable. This editorial questions whether mean arterial pressures over many hours accurately represent the systolic load,whether nighttime dipping varies from measure to measure or is a fixed phenomenon,whether the abrupt morning pressure rise is a risk factor or whether none of these issues are as important as the actual night time systolic blood pressure itself. The paper discusses the difference between medicated and nonmedicated white coat hypertensives in regard to the cardiovascular risk and suggests that further work is necessary to consider whether the quality and duration of sleep are important factors.
文摘There is arguably no less understood or more intriguing problem in hypertension that the"white coat"condition,the standard concept of which is significantly blood pressure reading obtained by medical personnel of authoritative standing than that obtained by more junior and less authoritative personnel and by the patients themselves.Using hospital-initiated ambulatory blood pressure monitoring,the while effect manifests as initial and ending pressure elevations,and,in treated patients,a low daytime profile.The effect is essentially systolic.Pure diastolic white coat hypertension appears to be exceedingly rare.On the basis of the studies,we believe that the white coat phenomenon is a common,periodic,neuro-endocrine reflex conditioned by anticipation of having the blood pressure taken and the fear of what this measurement may indicate concerning future illness.It does not change with time,or with prolonged association with the physician,particularly with advancing years,it may be superimposed upon essential hypertension,and in patients receiving hypertensive medication,blunting of the nighttime dip,which occurs in about half the patients,may be a compensatory mechanisms,rather than an indication of cardiovascular risk.Rather than the blunted dip,the morning surge or the widened pulse pressure,cardiovascular risk appears to be related to elevation of the average night time pressure.
