心血管病高危人群的隐匿性高血压检出率及相关筛查指标研究

Study on The Detection Rate of Latent Hypertension and Related Screening Indexes in High Risk Population of Cardiovascular Disease

目的通过对心血管疾病高危人群的隐匿性高血压检出率及相关危险因素进行分析,为进一步探索筛查隐匿性高血压的有效指标提供数据支持。方法从2020年1月至2021年6月,对我市35岁及以上年龄的常住人口进行了心血管病高危人群的初步筛查,共筛查出高危人群300名,从中选取无高血压史且诊室血压<140/90mmHg的100人展开分析,通过单因素比较及多因素回归分析,探讨了隐匿性高血压的影响因素,并计算出不同指标的截断值,分别计算隐匿性高血压的敏感度和特异度。结果所有高位对象的诊室血压平均值为(141.23±18.28)mmHG/(81.29±10.29)mmHg;诊室高血压占比66%,ABPM异常表达占76%;结合高危人群的ABPM和血压结果,在没有高血压疾病史的人群中诊室血压均值低于140/90mmHG,其中有ABPM异常的隐匿性高血压患者56人,检出率为56%,结合诊室SBP和DBP的MH检出结果表现为升高趋势(P<0.05)。单因素对比高危对象中血压正常组和MH组基本资料,两组性别、BMI、TG、SBP和DBP差异显著(P<0.05)。结合高危对象SBP、DBP和BMI水平线对ROC曲线进行绘制,下面积分别是0.653、0.678和0.613。若诊室SBP截断值为124mmHg,敏感度和特异度分别为68.8%和62.4%,约登指数为28.5%;在本研究中,BMI截断值为26kg/m^(2)时,筛查隐匿性高血压的敏感度和特异度分别为42%和75%,约登指数为19%。如果使用阳性筛查阀值为SBP>124mmHg或者DBP>74mmHg,敏感度和特异度分别为88%和47%;而如果使用阳性阀值为SBP>124mmHg或者DBP>74mmHg或者BMI>26kg/m^(2),则敏感度和特异度分别为92%和41%。结论心血管病高危人群隐匿性高血压的患病率较高。而通过动态血压监测能够大大提升对诊室血压正常偏高或超重肥胖的高危人群进行隐匿性高血压的筛查。

Objective To analyze the detection rate of occultive hypertension and related risk factors in high-risk groups of cardiovascular disease,and to provide data support for further exploration of effective indicators for screening concealed hypertension.Methods From January 2020 to June 2021,a preliminary screening of high-risk groups of cardiovascular disease was conducted among the resident population aged 35 years and above in our city.A total of 300 high-risk groups were screened,and 100 of them with no history of hypertension and blood pressure<140/90mmHg in the office were selected for analysis.The influencing factors of occult hypertension were discussed,and the cut-off values of different indexes were calculated to calculate the sensitivity and specificity of occult hypertension respectively.Results The average clinic blood pressure of all high-risk objects was(141.23±18.28)mmHg/(81.29±10.29)mmHg,with 66%showing clinic hypertension and 76%indicating abnormal ABPM.Among the individuals without a history of hypertension and with clinic blood pressure less than 140/90mmHg,there were 56 patients with concealed hypertension detected by ABPM,with a detection rate of 56%.The MH detection results based on SBP and DBP showed an increasing trend(P<0.05).Basic data comparisons revealed significant differences in gender,BMI,TG,SBP,and DBP between the individual with normal blood pressure and those with MH(P<0.05).The ROC curve was plotted based on the SBP,DBP,and BMI levels of the high-risk objects,with AUC of 0.653,0.678,and 0.613,respectively.The sensitivity and specificity of clinic SBP with a cut-off value of 124mmHg were 68.8%and 62.4%,respectively,and the Joden index was 28.5%.For BMI with a cut-off value of 26kg/m^(2),the sensitivity and specificity for screening concealed hypertension were 42%and 75%,respectively,and the Joden index was 19%.If the positive screening threshold was set as SBP>124mmHg or DBP>74mmHg,the sensitivity and specificity were 88%and 47%,respectively.If the positive screening threshold was set as SBP>124mmHg or DBP>74mmHg or BMI>26kg/m^(2),the sensitivity and specificity were 92%and 41%,respectively.Conclusion The detection rate of concealed hypertension is relatively high in the high-risk population of cardiovascular disease.The effective screening of concealed hypertension can be achieved through dynamic blood pressure monitoring for high-risk individuals with clinic blood pressure that is normal,but slightly high,or overweight and obese.The results of this study provide important data support for screening concealed hypertension in high-risk populations.