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Beyaz önlük hipertansiyonunda uç organ hasarı ile vücut kitle indeksi arasındaki ilişki

Yıl 2019, , 50 - 54, 29.01.2019
https://doi.org/10.5472/marumj.518986

Öz

Amaç: Beyaz önlük hipertansiyonu (BÖH) poliklinik ölçümlerinde
kan basıncının yüksek bulunması ancak ambulatuvar kan basıncı
veya ev ölçümleri sırasında kan basınçlarının normal seyretmesidir.
Biz bu çalışmada, obezitenin uç organ hasarına etkisini ve vücut
kitle indeksi (VKİ) ile BÖH’ün neden olduğu uç organ hasarı
arasındaki ilişkiyi incelemeyi amaçladık.
Hastalar ve Yöntemler: Çalışmamıza polikliniğimize başka
nedenlerle başvuran veya hastalık saptanmayan sağlıklı kişiler
arasından hipertansiyon tanısı almamış ya da hipertansiyon
nedeniyle tedavi edilmemiş olan bireyler dâhil edildi. Gündüz
ölçüm değerleri kriter alınarak sistolik kan basıncı 135 mmHg,
diastolik kan basıncı 85 mmHg’nın altındaki değerler BÖH olarak
kabul edildi. Hastalar uç organ hasarı yönünden değerlendirildi.
Ekokardiografi ile sol ventrikül kitlesi (SVK) ölçüldü. Retinopati
araştırıldı. Mikroalbuminüri düzeyine bakıldı.
Bulgular: Ortalama sol ventrikül kitle indeksi (SVKİ) ve
SVK değerleri sırasıyla 96,29 ± 25,64 gr/m2 ve 170,87 ± 50,17
gr bulundu. Hipertansif retinopati sıklığı %17’idi. Kan basıncı
değerlerinden bağımsız olarak VKİ ile SVK ve SVKİ arasında
korelasyon bulundu.
Sonuç: Beyaz önlük hipertansiyonunun masumiyeti konusunda
çelişkili ifadeler vardır. Değişen kan basıncı değerlerinden bağımsız
olarak farklı uç organ hasarları görülmektedir. Obez olan BÖH
hastalarında kardiyak yetmezlik daha sık ve erken görülmektedir.
Sonuç olarak BÖH’lü bir hasta izlenirken kan basınçlarında
anlamlı değişiklik olmaksızın uç organ hasarı oluşabilmektedir.

Kaynakça

  • 1. MacMahon S, Peto R, Cutler J, et al. Blood pressure, stroke, and coronary heart disease.Part 1. Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 1990; 335: 765-74. doi: 10.1016/0140-6736(90)90878-9
  • 2. O’Brien E, Coats A, Owens P, et al. Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British hypertension society. BMJ 2000; 320(7242):1128- 34. doi: 10.1136/bmj.320.7242.1128
  • 3. Erdogan D, Caliskan M, Gullu H, et al. Aortic elastic properties and left ventricular diastolic function in white-coat hypertensive individuals. Blood Press Monit 2006; 11: 191- 8. doi: 10.1097/01.mbp.000.020.9079.17246.7d
  • 4. Ihm SH, Youn HJ, Park CS, et al. Target organ status in white-coat hypertensives: usefulness of serum procollagen type I propeptide in the respect of left ventricular diastolic dysfunction. Circ J 2009; 73: 100-5. doi: 10.1253/circj.CJ- 08-0464
  • 5. Ben-Dov IZ, Kark JD, Mekler J, Shaked E, Bursztyn M. The white coat phenomenon is benign in referred treated patients: a 14-year ambulatory blood pressure mortality study. J Hypertens 2008; 26: 699-705. doi: 10.1097/ HJH.0b013e3282f4b3bf
  • 6. Pioli MR, Ritter AM, de Faria AP, Modolo R. White coat syndrome and its variations: differences and clinical impact. Integr Blood Press Control 2018;11:73-9. doi:10.2147/IBPC. S152761
  • 7. Seravalle G, Grassi G. Obesity and hypertension. Pharmacol Res 2017;122:1–7. doi: 10.1016/j.phrs.2017.05.013.
  • 8. James PA, Oparil S, Carter BL, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014;311:507-20. doi: 10.1001/jama.2013.284427
  • 9. Wagener HP, Clay GE, Gipner JF. Classification of retinal lesions in the presence of vascular hypertension: Report submitted to the American Ophthalmological Society by the committee on Classification of Hypertensive Disease of the Retina. Trans Am Ophthalmol Soc 1947; 45: 57-73.
  • 10. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/ AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/ NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018; 71:e13. doi: 10.1161/ HYP.000.000.0000000066
  • 11. Julius S, Mejia A, Jones K, et al. “White coat” versus “sustained” borderline hypertension in Tecumseh, Michigan. Hypertension 1990; 16:617-23.
  • 12. Muscholl MW, Hense HW, Brüockel U, Düoring A, Riegger GAJ, Schunkert H. Changes in left ventricular structure and function in patients with white coat hypertension: crosssectional survey. Lancet 1998;317:565-70.
  • 13. Verdecchia P, Schillaci G, Borgioni C, et al. White coat hypertension and white coat effect. Similarities and differences. Am J Hypertens 1995; 8:790-8. doi: 10.1016/0895-7061(95)00151-E
  • 14. Owens PE, Lyons SP, Rodriguez SA, O’Brien ET. Is elevation of clinic blood pressure in patients with white coat hypertension who have normal ambulatory blood pressure associated with target organ changes? J Hum Hypertens 1998;12:743-8.
  • 15. Martínez MA, Moreno A, Aguirre de Cárcer A, Cabrera R, Rocha R, Torre A. Frequency and determinants of microalbuminuria in mild hypertension: a primary-carebased study. J Hypertens 2001; 19: 319-26.
  • 16. Di Mauro S, Spallina G, Scalia G, et al. Urinary albumin excretion in elderly patients with white coat hypertension. Arch Gerontol Geriatr 1999; 28: 23-9. doi: 10.1016/S0167- 4943(98)00121-6
  • 17. Kristensen KS, Hoegholm A, Bang LE, Gustavsen PH, Poulsen CB. No impact of blood pressure variability on microalbuminuria and left ventricular geometry: analysis of daytime variation, diurnal variation and ‘white coat’ effect. Blood Press Monit 2001; 6:125-31.
  • 18. Palatini P, Mormino P, Santonastaso M, et al. Target-organ damage in stage I hypertensive subjects with white coat and sustained hypertension: results from the HARVEST study. Hypertension 1998; 31: 57-63.
  • 19. Schmieder RE, Messerli FH. Does obesity influence early target organ damage in hypertensive patients? Circulation 1993; 87:1482-88.
  • 20. Wong TY, Klein R, Sharrett AR, et al. Retinal arteriolar diameter and risk for hypertension. Ann Intern Med 2004; 140:248-55. doi: 10.7326/0003-4819-140-4- 200402.170.00006
  • 21. Pose-Reino A, González-Juanatey JR, Pastor C, et al. Clinical implications of white coat hypertension. Blood Press 1996; 5:264-73. doi: 10.3109/080.370.59609078058
  • 22. Cerasola G, Cottone S, Nardi E, et al. White-coat hypertension and cardiovascular risk. J Cardiovasc Risk 1995; 2:545-9. doi: 10.1177/174.182.679500200609

The relation between body mass index and end organ damage in white coat hypertension

Yıl 2019, , 50 - 54, 29.01.2019
https://doi.org/10.5472/marumj.518986

Öz

Objective: White coat hypertension (WCH) is characterized by
blood pressure, which is high in the outpatient clinic and normal
either on ambulatory blood pressure (BP) monitoring or home
BP monitoring. In this study, our objective was to investigate the
effects of obesity on end organ damage and the correlation between
body mass index (BMI) and end organ damage caused by WCH.
Patients and Methods: Individuals, who applied to our
outpatient clinic due to other complaints or who were not diagnosed
with or treated for hypertension, were enrolled in our study. Based
on daytime values, systolic blood pressures below 135mmHg
and diastolic blood pressures below 85mmHg were considered as
WCH. The patients were examined for the findings of end organ
damage. The left ventricular mass (LVM) was measured with
echocardiography. Findings of hypertensive retinopathy were
evaluated and albumin levels were measured.
Results: The mean left ventricular mass index (LVMI) and
LVM values were 96.29±25.6g/m2 and 170.87±50.17g respectively.
The rate of hypertensive retinopathy was 17%. We determined
a significant correlation between BMI and LVMI independently
from blood pressure levels.
Conclusion: There are conflicting conclusions about the risks
related to WCH. However, several types of end organ damage
can be observed independently from the blood pressure levels in
this group of patients. Cardiac failure is more common and has
an early onset in obese patients with WCH. In conclusion, end
organ damage may emerge during the follow-up of WCH patients
without a significant change in the blood pressure values.

Kaynakça

  • 1. MacMahon S, Peto R, Cutler J, et al. Blood pressure, stroke, and coronary heart disease.Part 1. Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 1990; 335: 765-74. doi: 10.1016/0140-6736(90)90878-9
  • 2. O’Brien E, Coats A, Owens P, et al. Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British hypertension society. BMJ 2000; 320(7242):1128- 34. doi: 10.1136/bmj.320.7242.1128
  • 3. Erdogan D, Caliskan M, Gullu H, et al. Aortic elastic properties and left ventricular diastolic function in white-coat hypertensive individuals. Blood Press Monit 2006; 11: 191- 8. doi: 10.1097/01.mbp.000.020.9079.17246.7d
  • 4. Ihm SH, Youn HJ, Park CS, et al. Target organ status in white-coat hypertensives: usefulness of serum procollagen type I propeptide in the respect of left ventricular diastolic dysfunction. Circ J 2009; 73: 100-5. doi: 10.1253/circj.CJ- 08-0464
  • 5. Ben-Dov IZ, Kark JD, Mekler J, Shaked E, Bursztyn M. The white coat phenomenon is benign in referred treated patients: a 14-year ambulatory blood pressure mortality study. J Hypertens 2008; 26: 699-705. doi: 10.1097/ HJH.0b013e3282f4b3bf
  • 6. Pioli MR, Ritter AM, de Faria AP, Modolo R. White coat syndrome and its variations: differences and clinical impact. Integr Blood Press Control 2018;11:73-9. doi:10.2147/IBPC. S152761
  • 7. Seravalle G, Grassi G. Obesity and hypertension. Pharmacol Res 2017;122:1–7. doi: 10.1016/j.phrs.2017.05.013.
  • 8. James PA, Oparil S, Carter BL, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014;311:507-20. doi: 10.1001/jama.2013.284427
  • 9. Wagener HP, Clay GE, Gipner JF. Classification of retinal lesions in the presence of vascular hypertension: Report submitted to the American Ophthalmological Society by the committee on Classification of Hypertensive Disease of the Retina. Trans Am Ophthalmol Soc 1947; 45: 57-73.
  • 10. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/ AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/ NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018; 71:e13. doi: 10.1161/ HYP.000.000.0000000066
  • 11. Julius S, Mejia A, Jones K, et al. “White coat” versus “sustained” borderline hypertension in Tecumseh, Michigan. Hypertension 1990; 16:617-23.
  • 12. Muscholl MW, Hense HW, Brüockel U, Düoring A, Riegger GAJ, Schunkert H. Changes in left ventricular structure and function in patients with white coat hypertension: crosssectional survey. Lancet 1998;317:565-70.
  • 13. Verdecchia P, Schillaci G, Borgioni C, et al. White coat hypertension and white coat effect. Similarities and differences. Am J Hypertens 1995; 8:790-8. doi: 10.1016/0895-7061(95)00151-E
  • 14. Owens PE, Lyons SP, Rodriguez SA, O’Brien ET. Is elevation of clinic blood pressure in patients with white coat hypertension who have normal ambulatory blood pressure associated with target organ changes? J Hum Hypertens 1998;12:743-8.
  • 15. Martínez MA, Moreno A, Aguirre de Cárcer A, Cabrera R, Rocha R, Torre A. Frequency and determinants of microalbuminuria in mild hypertension: a primary-carebased study. J Hypertens 2001; 19: 319-26.
  • 16. Di Mauro S, Spallina G, Scalia G, et al. Urinary albumin excretion in elderly patients with white coat hypertension. Arch Gerontol Geriatr 1999; 28: 23-9. doi: 10.1016/S0167- 4943(98)00121-6
  • 17. Kristensen KS, Hoegholm A, Bang LE, Gustavsen PH, Poulsen CB. No impact of blood pressure variability on microalbuminuria and left ventricular geometry: analysis of daytime variation, diurnal variation and ‘white coat’ effect. Blood Press Monit 2001; 6:125-31.
  • 18. Palatini P, Mormino P, Santonastaso M, et al. Target-organ damage in stage I hypertensive subjects with white coat and sustained hypertension: results from the HARVEST study. Hypertension 1998; 31: 57-63.
  • 19. Schmieder RE, Messerli FH. Does obesity influence early target organ damage in hypertensive patients? Circulation 1993; 87:1482-88.
  • 20. Wong TY, Klein R, Sharrett AR, et al. Retinal arteriolar diameter and risk for hypertension. Ann Intern Med 2004; 140:248-55. doi: 10.7326/0003-4819-140-4- 200402.170.00006
  • 21. Pose-Reino A, González-Juanatey JR, Pastor C, et al. Clinical implications of white coat hypertension. Blood Press 1996; 5:264-73. doi: 10.3109/080.370.59609078058
  • 22. Cerasola G, Cottone S, Nardi E, et al. White-coat hypertension and cardiovascular risk. J Cardiovasc Risk 1995; 2:545-9. doi: 10.1177/174.182.679500200609
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Makaleler
Yazarlar

Atakan Demır

Mevlut Tamer Dıncer Bu kişi benim

Yayımlanma Tarihi 29 Ocak 2019
Yayımlandığı Sayı Yıl 2019

Kaynak Göster

APA Demır, A., & Dıncer, M. T. (2019). The relation between body mass index and end organ damage in white coat hypertension. Marmara Medical Journal, 32(1), 50-54. https://doi.org/10.5472/marumj.518986
AMA Demır A, Dıncer MT. The relation between body mass index and end organ damage in white coat hypertension. Marmara Med J. Ocak 2019;32(1):50-54. doi:10.5472/marumj.518986
Chicago Demır, Atakan, ve Mevlut Tamer Dıncer. “The Relation Between Body Mass Index and End Organ Damage in White Coat Hypertension”. Marmara Medical Journal 32, sy. 1 (Ocak 2019): 50-54. https://doi.org/10.5472/marumj.518986.
EndNote Demır A, Dıncer MT (01 Ocak 2019) The relation between body mass index and end organ damage in white coat hypertension. Marmara Medical Journal 32 1 50–54.
IEEE A. Demır ve M. T. Dıncer, “The relation between body mass index and end organ damage in white coat hypertension”, Marmara Med J, c. 32, sy. 1, ss. 50–54, 2019, doi: 10.5472/marumj.518986.
ISNAD Demır, Atakan - Dıncer, Mevlut Tamer. “The Relation Between Body Mass Index and End Organ Damage in White Coat Hypertension”. Marmara Medical Journal 32/1 (Ocak 2019), 50-54. https://doi.org/10.5472/marumj.518986.
JAMA Demır A, Dıncer MT. The relation between body mass index and end organ damage in white coat hypertension. Marmara Med J. 2019;32:50–54.
MLA Demır, Atakan ve Mevlut Tamer Dıncer. “The Relation Between Body Mass Index and End Organ Damage in White Coat Hypertension”. Marmara Medical Journal, c. 32, sy. 1, 2019, ss. 50-54, doi:10.5472/marumj.518986.
Vancouver Demır A, Dıncer MT. The relation between body mass index and end organ damage in white coat hypertension. Marmara Med J. 2019;32(1):50-4.