诊室自助电子血压计测量在高血压诊断及疗效评估中的价值

The Value of Self-initiated Office Blood Pressure Measurement in the Diagnosis of Hypertension and Evaluation of Treatment Efficacy

目的:探讨诊室自助电子血压计测量(SOBPM)在高血压诊断及疗效评估中的价值,并与诊室血压测量(OBPM)、家庭血压监测(HBPM)以及24小时动态血压监测(ABPM)进行比较。方法:连续入选2019年8月至2021年2月就诊于福建医科大学附属第一医院心血管内科门诊的高血压患者169例,所有患者进行SOBPM、OBPM、HBPM、ABPM,用重复测量方差分析比较4种血压测量方法所测血压及心率的差异,采用Pearson相关性分析比较不同血压测量方法所测血压与左心室质量指数的相关性。结果:118例患者被纳入最终分析。就收缩压而言,SOBPM值高于HBPM值和白天ABPM均值,但低于OBPM值(t分别为8.703、8.511、-9.818,P均<0.001);在舒张压方面,SOBPM值高于白天ABPM均值,低于OBPM值(t分别为2.796、-4.655,P分别为0.006和<0.001);SOBPM所测心率高于HBPM值及白天ABPM均值(t分别为5.224、2.987,P分别为<0.001和0.003),而SOBPM与OBPM所测心率间的差异无统计学意义(t=0.064,P=0.945)。在与ABPM评估血压控制情况的一致率上,HBPM高于SOBPM和OBPM(χ^(2)分别为16.21、15.22,P均<0.001),而SOBPM与OBPM间的差异无统计学意义(χ^(2)=0.02,P=0.896)。白天ABPM收缩压、舒张压均值与左心室质量指数呈正相关(r分别为0.296、0.286,P均<0.01),而SOBPM所测收缩压和舒张压与左心室质量指数均无显著相关性(r分别为0.126、0.125,P均>0.05)。结论:SOBPM可在一定程度上降低但不能完全消除白大衣效应,其所测血压与左心室质量指数无显著相关性。

Objectives:To assess the value of self-initiated office blood pressure measurement(SOBPM)in the diagnosis of hypertension and evaluation of treatment efficacy as compared with office blood pressure measurement(OBPM),home blood pressure measurement(HBPM)and 24-hour ambulatory blood pressure monitoring(ABPM).Methods:A total of 169 consecutive hypertensive outpatients seeking medical care at the Department of Cardiovascular Medicine,The First Affiliated Hospital of Fujian Medical University from August 2019 to February 2021 were enrolled.SOBPM,OBPM,HBPM and ABPM were performed in all patients.The differences of blood pressure and heart rate measured by the 4 methods were compared with the repeated measures ANOVA.The Pearson correlation analysis was employed to calculate the correlations between different blood pressure measurements and left ventricular mass index.Results:Finally,118 patients were included in the analysis.As for systolic blood pressure(SBP),the reading of SOBPM was significantly higher than that of HBPM and mean daytime-ABPM but lower than that of OBPM(t=8.703,8.511,-9.818,respectively;all P<0.001).In the diastolic blood pressure(DBP)measurement,the reading of SOBPM was significantly higher than that of mean daytime-ABPM but lower than that of OBPM(t=2.796,-4.655,respectively;P=0.006,P<0.001,respectively).The heart rate reading from SOBPM was significantly higher than that from HBPM and mean daytime heart rate(t=5.224,2.987,respectively;P<0.001,P=0.003,respectively),and heart rate measured by SOBPM and OBPM was similar(t=0.065,P=0.945).With regard to the control of blood pressure as determined by the ABPM,HBPM was more effective than SOBPM and OBPM(χ^(2)=16.21,15.22,respectively;both P<0.001),whereas no statistical difference was found between SOBPM and OBPM(χ^(2)=0.02,P=0.896).Mean SBP and DBP of the daytime-ABPM were positively correlated with left ventricular mass index(r=0.296,0.286,respectively;both P<0.01).However,no significant correlation was noted between left ventricular mass index and SOBPM-determined SBP and DBP(r=0.126,0.125,respectively;both P>0.05).Conclusions:SOBPM can ameliorate,but doesn’t completely eliminate the white coat effect.In addition,there is no significant correlation between blood pressure measured by this method and left ventricular mass index.