Bayó Joan, Cos Francesc Xavier, Roca Carme, Dalfó Antoni, Martín-Baranera Maria Montserrat, Albert Botey
PCT El Clot, ICS Consorci Sanitari Creu Roja d'Hospitalet, Faculty of Medicine, Biomedical Research Institute August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
Blood Press Monit. 2006 Apr;11(2):47-52. doi: 10.1097/01.mbp.0000200479.19046.94.
To determine the diagnostic performance of home blood pressure self-monitoring in white-coat hypertension using a 3-day reading program.
One hundred and ninety nontreated patients recently diagnosed with mild-moderate hypertension, selected consecutively at four primary healthcare centers in the city of Barcelona, were included. Each patient underwent morning and night home blood pressure self-monitoring with readings in triplicate for three consecutive days, followed by 24-h ambulatory blood pressure monitoring. The normality cut-off point value for home blood pressure self-monitoring and daytime ambulatory blood pressure monitoring was 135/85 mmHg.
Sixty-three patients were diagnosed with white-coat hypertension with home blood pressure self-monitoring (34.8%; 95% confidence interval: 27.9-42.2) and 74 with ambulatory blood pressure monitoring (41.6%; 95% confidence interval: 33.7-48.4). No statistically significant differences were observed between home blood pressure self-monitoring values and those of diurnal ambulatory blood pressure monitoring [137.4 (14.3)/82.1 (8.3) mmHg vs. 134.8 (11.3)/81.3 (9.5) mmHg]. Home blood pressure self-monitoring diagnostic performance parameters were sensitivity 50.0% (95% confidence interval: 38.3-61.7), specificity 75.7% (95% confidence interval: 66.3-83.2), positive and negative predictive values 58.7% (95% confidence interval: 45.6-70.8) and 68.6% (95% confidence interval: 59.4-76.7), respectively, and positive and negative probability coefficients 2.05 and 0.66, respectively. Analysis of different normality cut-off points using a receiver operating characteristic curve failed to produce significant improvement in the diagnostic performance of home blood pressure self-monitoring.
The diagnostic accuracy of a 3-day home blood pressure self-monitoring reading program in white-coat hypertension was poor. Ambulatory blood pressure monitoring continues to be the test of choice for this indication.
采用为期3天的读数方案，确定家庭血压自我监测对白大衣高血压的诊断效能。
纳入了190例最近在巴塞罗那市四个基层医疗中心连续入选的未经治疗的轻中度高血压患者。每位患者连续三天进行早晚家庭血压自我监测，每次读数取三次测量值，随后进行24小时动态血压监测。家庭血压自我监测和日间动态血压监测的正常临界值为135/85 mmHg。
通过家庭血压自我监测诊断为白大衣高血压的患者有63例（34.8%；95%置信区间：27.9 - 42.2），通过动态血压监测诊断为白大衣高血压的患者有74例（41.6%；95%置信区间：33.7 - 48.4）。家庭血压自我监测值与日间动态血压监测值之间未观察到统计学显著差异[137.4（14.3）/82.1（8.3）mmHg对134.8（11.3）/81.3（9.5）mmHg]。家庭血压自我监测的诊断效能参数分别为：灵敏度50.0%（95%置信区间：38.3 - 61.7）、特异度75.7%（95%置信区间：66.3 - 83.2）、阳性预测值和阴性预测值分别为58.7%（95%置信区间：45.6 - 70.8）和68.6%（95%置信区间：59.4 - 76.7），阳性概率系数和阴性概率系数分别为2.05和0.66。使用受试者工作特征曲线分析不同的正常临界值，未能显著提高家庭血压自我监测的诊断效能。
为期3天的家庭血压自我监测读数方案对白大衣高血压的诊断准确性较差。动态血压监测仍然是该适应症的首选检测方法。
