Beyaz Gömlek Hipertansiyonu ve Artmış Kardiyovasküler Risk

AIM: White coat hypertension has been described as continuously higher clinical blood pressure levels than day-time blood pressure levels. It has been known that the increased clinic blood pressure measurement in patients with primary hypertension is white coat effect. There is no consensus on pathophysiology, target organ damage and treatment of the white coat hypertension and white coat effect.

METHOD: This study consisted of 20 patients with white coat hypertension, 20 patients with white coat effect, 20 patients with primary hypertension and 10 normotensives. In this study group, we evaluated biochemical parameters, plasma norepinephrine level and systolicdiastolic function tests with echocardiography.

RESULTS: Age, body mass index and biochemical parameters, except triglyceride, were not different from each other in study groups. The triglyceride levels were 93.30±29.50 mg/dl, 152.05±53.20 mg/dl, 156.05±43.04 mg/dl and 205.30±76.10 mg/dl in controls, primary hypertension, white coat effect and white coat hypertension, respectively. The difference between white coat hypertension and control was statistically significant (p<0.001). Plasma norepinephrine values were 208.20±50.90 pg/ml, 295.30±65.00 pg/ml, 567.70±147.90 and 431.00±177.90 pg/ml in controls, primary hypertension, white coat effect and white coat hypertension, respectively. The differences between white coat hypertensioncontrols and white coat hypertension-primary hypertension groups were statistically significant for plasma norepinephrine values (p<0.05). Also, the differences between white coat effect-controls and white coat effect-primary hypertension groups were statistically significant for plasma norepinephrine values (p<0.001). E/A ratio of the groups were 1.34±0.21, 0.94±0.24, 0.83±0.26 and 0.98±0.17 in control, primary hypertension, white coat effect and white coat hypertension, respectively. The differences between white coat hypertension and control, white coat effect and control and primary hypertansion and control were statistically significant (p<0.05 for all). However the differences between primary hypertansion and white coat hypertension and white coat effect and primary hypertansion was statistically nonsignificant (p>0.05 for all).

CONCLUSION: In white coat hypertension, it can be said that echocardiographically diastolic dysfunction can accompany to increased sympathetic system activity.