Hypertension:极高龄患者治疗白大衣高血压有益

　　英国学者的一项研究表明，在极高龄人群中对白大衣性高血压实施降压治疗可能产生益处。论文于2012年11月19日在线发表于《高血压》（Hypertension）。

　　双盲随机HYVET试验在80岁以上高血压患者中对缓释吲哒帕胺联合培哚普利与匹配安慰剂进行了比较。此项研究为HYVET试验的子项目，并在受试者中测定了动态血压（ABP）。基线时112例患者测定了ABP，平均随访13个月后186例患者实施了测定。

　　结果显示，基线时诊室血压（CBP）较晨起ABP超出32/10 mmHg；50%的受试者符合白大衣性高血压确定标准。最高ABP出现在晨起时（平均140/80 mmHg），平均夜间血压为较低的124/72 mmHg，平均24小时血压为133/77 mmHg。随访期间，安慰剂组和治疗组的晨起ABP收缩/舒张压差异为6/5 mmHg，24小时ABP为8/5 mmHg，CBP为13/5 mmHg。鉴于HYVET试验中总体死亡和心血管事件减少，24小时以上的降压作用是其原因所在。

Does White Coat Hypertension Require Treatment Over Age 80?
Results of the Hypertension in the Very Elderly Trial Ambulatory Blood Pressure Side Project

Abstract

White coat hypertension is considered to be a benign condition that does not require antihypertensive treatment. Ambulatory blood pressure (ABP) was measured in 284 participants in the Hypertension in the Very Elderly Trial (HYVET), a double-blind randomized trial of indapamide sustained release 1.5 mg±perindopril 2 to 4 mg versus matching placebo in hypertensive subjects (systolic blood pressure 160–199 mm Hg) aged >80 years. ABP recordings (Diasys Integra II) were obtained in 112 participants at baseline and 186 after an average follow-up of 13 months. At baseline, clinic blood pressure (CBP) exceeded the morning ABP by 32/10 mm Hg. Fifty percent of participants fulfilled the established criteria for white coat hypertension. The highest ABP readings were in the morning (average 140/80 mm Hg), the average night-time pressure was low at 124/72 mm Hg, and the average 24-hour blood pressure was 133/77 mm Hg. During follow-up, the systolic/diastolic blood pressure placebo-active differences averaged 6/5 mm Hg for morning ABP, 8/5 mm Hg for 24-hour ABP, and 13/5 mm Hg for CBP. The lowering of blood pressure over 24 hours supports the reduction in blood pressure with indapamide sustained release±perindopril as the explanation for the reduction in total mortality and cardiovascular events observed in the main HYVET study. Because we estimate that 50% had white coat hypertension in the main study, this condition may benefit from treatment in the very elderly.