共同照护门诊2型糖尿病合并高血压患者家庭自测血压及诊室血压在不同血压控制标准下达标情况分析

Comparison of blood pressure control standards based on home blood pressure monitoring and automated office blood pressure in patients with type 2 diabetes and hypertension in Shared Care Clinic

目的基于合并高血压的2型糖尿病患者家庭自测血压及就诊时的诊室血压,探讨以2013版及2017版《中国2型糖尿病防治指南》中血压控制建议判断的达标情况差异。方法本研究中受试者入选标准:(1)在北大医院糖尿病共同照护门诊规律就诊的合并高血压的2型糖尿病患者,就诊时通过臂式血压计测量2次诊室血压并记录均值;(2)通过智能臂式血压计,患者于非同日清晨、晚餐前静息状态下将家庭自测血压通过APP自动上传数据≥3次/季度。将患者诊室血压数值及就诊前一季度患者家庭自测血压的均值配对比较,并以2013版及2017版《中国2型糖尿病防治指南》中血压控制的一般建议[分别是<130/80 mmHg、<140/80 mmHg(1 mmHg=0.133 kPa)]作为标准,分析基于不同血压数据来源、以两版指南为达标切点的达标率差异。以χ^(2)检验判断两组数据在达标率上的差异,以配对t检验分析同一患者两组血压数据间的差异。结果符合入选标准的患者40例,患者末次就诊前一季度家庭自测血压数据9.5(5.0,25.0)次。诊室收缩压及舒张压分别为(140.9±17.2)、(82.8±9.3)mmHg,家庭自测收缩压及舒张压分别为(128.5±11.1)、(76.0±9.3)mmHg(P均<0.001)。基于诊室血压结果,以<140/80 mmHg、<130/80 mmHg为标准的血压达标率分别为32.5%、5.0%;而基于家庭自测血压结果,以<140/80 mmHg、<130/80 mmHg为标准的血压达标率分别为60.0%、52.5%,两组血压数据的达标情况分布差异有统计学意义(χ^(2)=17.425,P=0.002)。诊室血压≥140/80 mmHg的患者,相比其家庭自测血压均值,诊室收缩压、舒张压分别高估(15.7±18.9)mmHg及(9.6±9.3)mmHg(P均<0.001);家庭自测平均血压<130/80 mmHg的患者,相比其家庭自测血压均值,诊室收缩压、舒张压分别高估(18.2±14.1)mmHg及(10.4±9.4)mmHg(P均<0.001)。结论相比于家庭自测血压,诊室血压对合并高血压的2型糖尿病患者显著高估血压达12.3/6.8 mmHg。当以诊室血压作为血压不达标的判断时存在对实际血压更大的高估。

Objective To explore the difference of blood pressure control rate recommended in Chinese type 2 diabetes guidelines ver.2013 and ver.2017 based on home blood pressure monitoring(HBPM)and automated office blood pressure(AOBP)in type 2 diabetes patients with hypertension.Methods Subjects were enrolled according to the following criteria:(1)type 2 diabetes patients with hypertension who were regularly followed in the Internet Plus Diabetes Shared Cared Clinic of Peking University First Hospital and whose AOBP was measured twice with an arm sphygmomanometer,with the mean value recorded;and(2)using an intelligent arm sphygmomanometer,the patients automatically uploaded their HBPM through APP≥3 times/quarter,each time they monitored blood pressure in the resting state on the morning or before dinner on separate days.The AOBP and the mean value of HBPM before visit were compared.The difference of the control rate of AOBP and HBPM based on the recommendations of the two versions of guidelines[<130/80 mmHg,<140/80 mmHg(1 mmHg=0.133 kPa)]was analyzed.Chisquare test was used to determine the difference between the blood pressure control rate of AOBP and HBPM;paired t-test was used to analyze the difference between the two sources of blood pressure in the same patient.Results Forty patients met the inclusion criteria,and they had 9.5(5.0,25.0)times of HBPM in the first quarter before the last visit.The systolic blood pressure(SBP)and diastolic blood pressure(DBP)of AOBP were(140.9±17.2)mmHg and(82.8±9.3)mmHg,respectively.The SBP and DBP of HBPM were(128.5±11.1)mmHg and(76.0±9.3)mmHg,respectively(P<0.001).Based on the results of AOBP,the blood pressure control rates of<140/80 mmHg and<130/80 mmHg were 32.5%and 5.0%respectively,while the blood pressure control rates of<140/80 mmHg and<130/80 mmHg were 60.0%and 52.5%respectively based on the results of HBPM.There was a statistically significant difference between the two groups(χ^(2)=17.425,P=0.002).The SBP and DBP of AOBP were overestimated by(15.7±18.9)mmHg and(9.6±9.3)mmHg,respectively(P<0.001),compared with the mean value of HBPM in patients whose blood pressure of AOBP was≥140/80 mmHg.The SBP and DBP of AOBP were overestimated by(18.2±14.1)mmHg and(10.4±9.4)mmHg respectively(P<0.001),compared with the mean value of HBPM in patients whose blood pressure of HBPM was<130/80 mmHg.Conclusion Compared with the HBPM,AOBP significantly overestimates the blood pressure of type 2 diabetes patients with hypertension by about 12.3/6.8 mmHg.When the AOBP is taken as the judgment of blood pressure not reaching the target,the blood pressure may be more overestimated.