家庭血压测量诊断白大衣高血压及隐匿性高血压的准确性研究

Accuracy of home versus ambulatory blood pressure monitoring in the diagnosis of white-coat and masked hypertension

目的:探究家庭血压测量和24 h动态血压(以下称动态血压)监测诊断白大衣高血压及隐匿性高血压的准确性。方法:研究对象为全国多中心动态血压及家庭血压登记研究中上海地区的受试者,均接受动态血压监测,并进行了诊室血压测量和7 d家庭血压测量。本组总计纳入1067例患者,平均年龄为57.5岁,男性占39.9%。依据相关高血压指南,白大衣高血压定义为诊室测平均收缩压≥140 mmHg和(或)平均收缩压≥90 mmHg,而动态血压监测正常(平均收缩压<130 mmHg且平均舒张压<80 mmHg)或家庭血压测量正常(平均收缩压<135 mmHg且平均舒张压<85 mmHg);隐匿性高血压为诊室测量血压正常而动态血压升高或家庭血压升高。结果:在1067例患者中,接受降压药物治疗的高血压患者为867例,未治疗患者200例。在未治疗患者中,动态血压监测和家庭血压测量诊断白大衣高血压的患病率分别为10.0%和17.0%(P=0.04),动态血压监测和家庭血压测量诊断隐匿性高血压的患病率分别为26.5%和14.5%(P=0.003)。以动态血压监测为标准,无论未治疗患者还是治疗患者,家庭血压测量诊断白大衣及隐匿性高血压的灵敏度都较低(43%~86%),特异度较高(91%~99%),阳性预测值较低(46%~91%),阴性预测值较高(84%~100%)。动态血压监测与家庭血压测量间的诊断一致性为81%~90%,Kappa值为0.43到0.78。结论:家庭血压测量诊断白大衣及隐匿性高血压的灵敏度较低,但特异度较高。因此,尽管家庭血压测量不能替代动态血压监测,但可作为其有益的补充。

Objective:To investigate accuracy of home blood pressure(BP)monitoring in the diagnosis of white-coat and masked hypertension in comparison with ambulatory BP monitoring.Methods:Participants were patients enrolled in the China Ambulatory and Home BP Registry,and underwent clinic,home,and 24 h ambulatory BP measurements.White-coat hypertension was defined as an elevated clinic systolic/diastolic BP(≥140/90 mmHg)and a normal 24 h ambulatory(<130/80 mmHg)or home systolic/diastolic BP(<135/85 mmHg),while masked hypertension as a normal clinic systolic/diastolic BP(<140/90 mmHg)and an elevated 24 h ambulatory(≥130/80 mmHg)or home systolic/diastolic BP(≥135/85 mmHg).Results:In untreated patients(n=200),the prevalence of white-coat hypertension(10.0%vs 17.0%),masked hypertension(26.5%vs 14.5%)significantly(P=0.04)differed between 24 h ambulatory and home BP monitoring.Regardless of the treatment status,compared with 24 h ambulatory BP,home BP measurement had low sensitivity(range43%-86%)but high specificity(91%-99%),and accordingly low positive predictive values(46%-91%)but high negative predictive values(84%-100%).These two modalities had moderate diagnostic agreement(81%-90%)and Kappa statistic(0.43-0.78).Conclusion:Home BP monitoring has high specificitybut low sensitivity in the diagnosis of white-coat and masked hypertension.It may behave as a complementary to,albeit not a replacement of ambulatory BP monitoring.