白袍高血壓－－高血壓的重要課題

White Coat Hypertension-An Important Issue of Hypertension

白袍高血壓在民眾中並非少見，其盛行率隨著採用之移動式血壓平均值或居家血壓的診斷標準而有所不同，約在10~45％。在大多數的報告其診斷準據是隨機血壓≧140／90 mmHg，而移動式血壓平均值或居家血壓＜135／85 mmHg。白袍高血壓的發生機轉迄今尚未清楚，但與精神情緒因素可能有關。目前的研究指出這種高血壓患者沒有腎素-血管昇壓素-醛酮系統之基因多型態異常。白袍高血壓者之移動式血壓的常態與正常血壓者相似。白袍高血壓者與正常血壓者有類似之目標器官之功能與構造的影響。大多數的報告發現白袍高血壓者有與正常血壓者相似之較低的心血管罹病率而認為白袍高血壓是良性的。因此，其治療以生活修正為主，而且加以追蹤，不宜服用抗高血壓藥物。對白袍高血壓的瞭解可以避免在不穩定型高血壓患者之診斷的錯誤而造成不當的治療，亦可以減少鉅額的醫療費用。。白袍高血壓是高血壓的重要課題，具有醫學、社會及經濟方面的重要性。

White coat hypertension is not infrequent in the general population. Its prevalence is 10~45%, varying with the diagnostic criteria of ambulatory blood pressure (ABP) or home blood pressure (HBP). Currently, white coat hypertension is defined as a casual blood pressure ≥140 mmHg systolic and/or ≥90 mmHg diastolic with the average ambulatory blood pressure or home blood pressure < 135 mmHg systolic and/or < 85 mmHg diastolic. The etiology of WCH is not clear and it may relate to interacting psychological variables. None of the major genetic polymorphisms in the RAA system were abnormal in subjects with WCH. The normalcy of ABP is not significantly different between normotensive pleople and subjects with WCH. The frequency of target-organ damage or cardiovascular morbidity in subjects with WCH is also not significantly different from that in normotensive people. Therefore, WCH is considered a benign condition in most reports. Pharmacologic treatment is not suggested, instead, treatment should consist of life adjustment. Also, regular follow-up with ABPM is need. Detecting WCH can avoid misdiagnosis and improper treatment for subjects with labile hypertension. WCH is a major subject of hypertension and thus of medical, social and economic importance.