家庭自测血压的可靠性

Reliability of Home Blood Pressure Measurement

目的通过对3种血压测量方法进行比较,为家庭自测血压用于临床和科研积累经验和科学数据。方法利用"代用盐对高血压患者及其家庭成员降压效果随机双盲对照试验研究"中收集的同一研究对象(n=220)不同方法获得血压(门诊血压、家庭自测血压和动态血压)测量数据,以动态血压数据作为参照,比较家庭血压及门诊血压与动态血压的一致性。干预前,217人3种血压测量方法数据均合格;干预结束时,189人3种血压测量方法数据均合格;将干预前和干预结束时测量合格的数据合并分析(n=406)。利用Bland-Altman对3种测量方法测得的血压水平进行组内一致性检验,并进行Person相关性分析;利用McNemar卡方检验比较3种方法的个体内一致率。结果门诊血压、动态血压和家庭自测血压3种方法测得的血压水平(收缩压/舒张压)分别为(149.5±16.4)/ (87.2±9.5)、(137.8±17.1)/(83.2±10.3)和(138.0±14.2)/(82.4±9.3)mm Hg。家庭血压与动态血压的相关性优于门诊血压与动态血压的相关性,相关系数(收缩压/舒张压)分别为(0.55/0.62)和(0.36/0.46)。以动态血压为参照,家庭自测血压水平与动态血压(收缩压/舒张压)差异无统计学意义(-0.2/-0.7 mm Hg,P>0.05),而门诊血压水平显著高于动态血压水平(11.7/4.0 mm Hg,P<0.05);家庭自测血压的收缩压个体内差异显著优于门诊血压(≤|5| mm Hg为28.3%vs 1 6.5%,P<0.05;≤|10| mm Hg为49.7%vs 33.5%,P<0.05),舒张压个体差异略高于门诊血压,但差异无统计学意义(P>0.05)。结论与动态血压测量值相比,家庭自测血压比门诊血压更准确。

Objective To verify the reliability of home blood pressure measurement in clinic and research works by comparison three methods [home（H）, office（O） and ambulatory（A）] of blood pressure（BP） measurements. Methods The ＂study-effects of salt substitution on blood pressure among the hypertensive patients and their families＂ was a randomized, double blinded control trial. In this study, BP was measured in 220 hypertensive patients using office, home and ambulatory BP measurements concurrently at the baseline and the end of the intervention. Two hundred seventeen patients had baseline eligible data, while at the end of the intervention, only 189 patients had eligible data. Bland-Altman method and Person＇s correlation analysis were used to compare the agreement of BP levels by 3 methods, and McNemar chi-square test compared rates of the agreement, assuming the ambulatory as the reference. Results The mean BP levels using office, ambulatory and home BP measurements were 149.5±16.4/87.2±9.5 mm Hg, 137.8±17.1/83.2±10.3 mm Hg, and 138.0±14.2/82.4±9.3 mm Hg, respectively. H BP was more strongly related with ambulatory BP （SBP/DBP）（ H： r = 0.55/0.62 vs O： r = 0. 36/0. 46 ）. The difference of BP between H and A was smaller[H：A -0.2 mm Hg/-0. 7 mm Hg vs O：A（11. 7 mm Hg/4.0 mm Hg）] . Intra-individual agreement between H and A SBP was significantly higher than that between O and A（28.3% vs 16.5% for ≤｜5｜ mm Hg and 49.7% vs 33.5% for ≤｜10｜ mm Hg, all P〈0. 05）; with slightly, not significantly differences of DBP measurement between H-A and O-A（P〉0.05）. Conclusion Home and ambulatory BP was more strongly related and better agreement than office-ambulatory BP measurement.