【摘要】 目的：通过自动诊室血压测量（AOBPM）、诊室血压测量（OBPM）、家庭血压测量（HBPM）以及动态血压测量（ABPM）测量原发性高血压患者的血压和心率，分析原发性高血压患者的心率白大衣效应。方法：入选1～2级原发性高血压患者528例，通过OBPM、HBPM测量血压及心率，获得诊室心率和家庭自测心率，分析白大衣高血压患者（n=169）和非白大衣高血压患者（n=359）的诊室心率和家庭自测心率的差异及心率白大衣效应（诊室心率-家庭自测心率）。169例患者接受OBPM、AOBPM、HBPM、ABPM四种不同测量方式，其中51例退出，共118例纳入统计，用重复测量方差分析比较4种方法所测心率的差异。对心率白大衣效应的相关性因素进行分析。结果：（1）诊室心率高于家庭自测心率[（74.07±9.99）次/min vs.(69.36±9.12)次/min,P<0.05]，心率白大衣效应为4.71次/min。（2）白大衣高血压患者的心率白大衣效应比非白大衣高血压患者更明显[（6.80±10.43）次/min vs.(3.72±8.35)次/min,P<0.05]。（3）对118例患者用4种测量方法所测的血压、心率进行成对比较，AOBPM较OBPM所测血压低5.93/2.36 mmHg(1 mmHg=0.133 kPa;t=-9.818和-4.655,P<0.05),AOBPM与OBPM所测心率的差异无统计学意义（t=0.064,P=0.945）。OBPM较HBPM、白天动态血压测量（d-ABPM）所测心率分别高4.40次/min(P<0.001)和2.33次/min(P=0.009);AOBPM较HBPM、白天-ABPM所测心率分别高4.44次/min(P<0.001)和2.36次/min(P=0.003)。（4）心率白大衣效应与收缩压白大衣效应、舒张压白大衣效应呈弱相关（r分别为0.208和0.134,P均<0.05），与诊室心率呈显著正相关（r=0.55,P<0.001），当诊室心率<70次/min，心率无明显白大衣效应。结论：原发性高血压患者的心率存在白大衣效应，白大衣高血压患者的心率白大衣效应明显大于非白大衣高血压患者。AOBPM能部分消除血压白大衣效应，但不能消除心率白大衣效应。更多还原

【Abstract】 Objectives: To investigate the white coat effect(WCE) on heart rate(HR) in essential hypertension patients.Methods: A total of 528 patients with grade 1-2 essential hypertension were enrolled. Blood pressure(BP) and HR were measured by automatic office blood pressure measurement(AOBPM), office blood pressure measurement(OBPM), home blood pressure monitoring(HBPM) and ambulatory blood pressure monitoring(ABPM). OBPM and HBPM were performed in all patients. All included patients were divided into white coat hypertension(WCH) group(n=169) and non-white coat hypertension group(n=359) according to their blood pressure measured in consultation and at home. The difference between HR obtained in consultation and average HR at home was compared to analyze the WCE on HR. In addition, OBPM,AOBPM, HBPM and ABPM were performed in 169 patients. 51 patients dropped out of the study, 118 patients were included in the final analysis. The differences in BP and HR among the measurements of 4 methods were compared with the repeated measures analysis of variance(ANOVA). The correlation factors of WCE on HR were analyzed by Spearman correlation.Results:(1) HR in consultation was significantly higher than average HR at home([74.07±9.99] bpm vs. [69.36±9.12]bpm, P<0.05).(2) The WCE on HR in patients with WCH was more obvious than in patients with non-WCH([6.80±10.43]bpm vs. [3.72±8.35] bpm, P<0.05).(3) The blood pressure measured by AOBPM was 5.93/2.36 mmHg lower than that measured by OBPM(t=-9.818 and-4.655, P<0.05). There was no statistically significant difference between HR measured by AOBPM and OBPM(t=0.064, P=0.945). The HR measured by OBPM was 4.40 bpm(P<0.001) and 2.33 bpm(P=0.009)higher than that by HBPM and daytime ambulatory blood pressure measurement(d-ABPM), respectively. The HR measured by AOBPM was 4.44 bpm(P<0.001) and 2.36 bpm(P=0.003) higher than that by HBPM and d-ABPM, respectively.(4)The WCE on HR was weakly correlated with the WCE on systolic BP and diastolic BP(r=0.208, 0.134, respectively, both P<0.05), and was positively correlated with clinic HR(r=0.55, P<0.05). Among patients with HR<70 bpm, there was no obvious WCE on HR.Conclusions: There is WCE on HR in essential hypertension patients, and the WCE on HR in patients with white coat hypertension is significantly greater than that in non-white coat hypertension patients. AOBPM can ameliorate, but does not completely eliminate the WCE on BP, but cannot eliminate the WCE on HR.更多还原